Provider Demographics
NPI:1043668692
Name:FITZPATRICK, KIM (LCSW)
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:
Last Name:FITZPATRICK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KIM
Other - Middle Name:
Other - Last Name:PRCHAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:343 4TH AVE
Mailing Address - Street 2:4E
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-2719
Mailing Address - Country:US
Mailing Address - Phone:917-442-2131
Mailing Address - Fax:
Practice Address - Street 1:1250 BROADWAY
Practice Address - Street 2:22ND FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-3701
Practice Address - Country:US
Practice Address - Phone:917-442-2131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-24
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0757371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical