Provider Demographics
NPI:1124530696
Name:FITZPATRICK, MEGAN M (LCSW)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:M
Last Name:FITZPATRICK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 DICKINSON CT
Mailing Address - Street 2:
Mailing Address - City:LEDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07852-2304
Mailing Address - Country:US
Mailing Address - Phone:973-927-6540
Mailing Address - Fax:973-927-0627
Practice Address - Street 1:120 PLYMOUTH RD
Practice Address - Street 2:
Practice Address - City:ERIAL
Practice Address - State:NJ
Practice Address - Zip Code:08081-3275
Practice Address - Country:US
Practice Address - Phone:856-904-1341
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-24
Last Update Date:2017-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor