Provider Demographics
NPI:1306499728
Name:FITZPATRICK, EILEEN E (MS, CAS)
Entity type:Individual
Prefix:MS
First Name:EILEEN
Middle Name:E
Last Name:FITZPATRICK
Suffix:
Gender:F
Credentials:MS, CAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4290 FAY RD
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13219-3045
Mailing Address - Country:US
Mailing Address - Phone:315-468-4536
Mailing Address - Fax:315-468-4536
Practice Address - Street 1:4290 FAY RD
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13219-3045
Practice Address - Country:US
Practice Address - Phone:315-468-4536
Practice Address - Fax:315-468-4536
Is Sole Proprietor?:No
Enumeration Date:2019-07-24
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist