Provider Demographics
NPI:1316661853
Name:FITZPATRICK, CANDACE A
Entity type:Individual
Prefix:
First Name:CANDACE
Middle Name:A
Last Name:FITZPATRICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CANDY
Other - Middle Name:A
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1400 POTTERY AVE
Mailing Address - Street 2:
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98366-3768
Mailing Address - Country:US
Mailing Address - Phone:360-895-5000
Mailing Address - Fax:877-516-9023
Practice Address - Street 1:1400 POTTERY AVE
Practice Address - Street 2:
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98366-3711
Practice Address - Country:US
Practice Address - Phone:360-895-5000
Practice Address - Fax:877-516-9023
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-28
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW608439821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical