Provider Demographics
NPI:1255359683
Name:FITZPATRICK, PATRICIA SCOTT (PHD)
Entity type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:SCOTT
Last Name:FITZPATRICK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:PATRICIA
Other - Middle Name:SCOTT
Other - Last Name:FITZPATRICK-THOMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:11755 RESERVOIR RD
Mailing Address - Street 2:
Mailing Address - City:WAYLAND
Mailing Address - State:NY
Mailing Address - Zip Code:14572-9614
Mailing Address - Country:US
Mailing Address - Phone:585-728-5927
Mailing Address - Fax:
Practice Address - Street 1:11755 RESERVOIR RD
Practice Address - Street 2:
Practice Address - City:WAYLAND
Practice Address - State:NY
Practice Address - Zip Code:14572-9614
Practice Address - Country:US
Practice Address - Phone:585-728-9228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0109601103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY100319FCOtherPREFERRED CARE
NY5209120OtherAETNA
NYP0200010960OtherEXCELLUS BLUE SHIELD
NY6892971002OtherVAUE OPTIONS GHI EMPIRE
NYP0200010960OtherEXCELLUS BLUE SHIELD