Provider Demographics
NPI:1124633821
Name:FISCHETTI, PATRICIA M (PSYD)
Entity type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:M
Last Name:FISCHETTI
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8312 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11228-2936
Mailing Address - Country:US
Mailing Address - Phone:718-745-7552
Mailing Address - Fax:718-921-9756
Practice Address - Street 1:8312 12TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11228-2936
Practice Address - Country:US
Practice Address - Phone:718-745-7552
Practice Address - Fax:718-921-9756
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-10
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY119011101YP2500X, 251S00000X
251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional