Provider Demographics
NPI:1023849908
Name:FITZPATRICK, JOAN (PSYD, MSW, BSW)
Entity type:Individual
Prefix:DR
First Name:JOAN
Middle Name:
Last Name:FITZPATRICK
Suffix:
Gender:F
Credentials:PSYD, MSW, BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 W BALTIMORE PIKE STE 100A
Mailing Address - Street 2:
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-5637
Mailing Address - Country:US
Mailing Address - Phone:610-717-5299
Mailing Address - Fax:
Practice Address - Street 1:77 W BALTIMORE PIKE STE 100A
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-5637
Practice Address - Country:US
Practice Address - Phone:610-717-5299
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-12
Last Update Date:2024-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC017486101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health