Provider Demographics
NPI:1790575488
Name:FITZPATRICK, DEVON (LSW)
Entity type:Individual
Prefix:
First Name:DEVON
Middle Name:
Last Name:FITZPATRICK
Suffix:
Gender:M
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2345 DORR ST
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43607-3423
Mailing Address - Country:US
Mailing Address - Phone:419-407-5342
Mailing Address - Fax:419-407-5371
Practice Address - Street 1:2345 DORR ST
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43607-3423
Practice Address - Country:US
Practice Address - Phone:419-407-5342
Practice Address - Fax:419-407-5371
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-07
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHQMHS101Y00000X, 101YA0400X
1041C0700X, 171M00000X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator