Provider Demographics
NPI:1215247366
Name:FITZPATRICK, JENNA T (LCSW)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:T
Last Name:FITZPATRICK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:T
Other - Last Name:ZITO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:5311 W NEWPORT AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60641-3333
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5311 W NEWPORT AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60641-3333
Practice Address - Country:US
Practice Address - Phone:518-330-6503
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-07
Last Update Date:2014-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY074652-1104100000X
NY080606-11041C0700X
IL1490161481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker