Provider Demographics
NPI:1952519829
Name:FITZ HUGH, PATRICIA (PSYD)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:FITZ HUGH
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25636 N STONEY KIRK CT
Mailing Address - Street 2:
Mailing Address - City:HAWTHORN WOODS
Mailing Address - State:IL
Mailing Address - Zip Code:60047-7539
Mailing Address - Country:US
Mailing Address - Phone:847-438-6665
Mailing Address - Fax:847-438-5292
Practice Address - Street 1:2222 14TH ST
Practice Address - Street 2:
Practice Address - City:WAUKEGAN
Practice Address - State:IL
Practice Address - Zip Code:60085-7708
Practice Address - Country:US
Practice Address - Phone:847-249-2400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL453110Medicare ID - Type Unspecified