Basic Information
| Provider Information | |||||||||
| NPI: | 1558412411 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FITZPATRICK | ||||||||
| FirstName: | JULIA | ||||||||
| MiddleName: | HEATHER | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 899 MAIN ST STE 1 | ||||||||
| Address2: | |||||||||
| City: | COLCHESTER | ||||||||
| State: | VT | ||||||||
| PostalCode: | 054464420 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8662842771 | ||||||||
| FaxNumber: | 6194354501 | ||||||||
| Practice Location | |||||||||
| Address1: | 158 C AVENUE | ||||||||
| Address2: | |||||||||
| City: | CORONADO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921183114 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6196024598 | ||||||||
| FaxNumber: | 6194354501 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/16/2007 | ||||||||
| LastUpdateDate: | 10/12/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/12/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | LCSW 28929 | CA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.