Provider Demographics
NPI:1548694094
Name:FITZPATRICK, ELLIOTT (PHD)
Entity type:Individual
Prefix:
First Name:ELLIOTT
Middle Name:
Last Name:FITZPATRICK
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1333 WICKERLEAF WAY
Mailing Address - Street 2:
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-8391
Mailing Address - Country:US
Mailing Address - Phone:570-294-2812
Mailing Address - Fax:
Practice Address - Street 1:111 WINDEL DR
Practice Address - Street 2:STE 213
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-4477
Practice Address - Country:US
Practice Address - Phone:919-333-4620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-01
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5006103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical