Provider Demographics
NPI:1801479456
Name:FITZPATRICK, KENNA MARIE (LGSW)
Entity type:Individual
Prefix:
First Name:KENNA
Middle Name:MARIE
Last Name:FITZPATRICK
Suffix:
Gender:F
Credentials:LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7608 HEARTHSIDE WAY APT 4019
Mailing Address - Street 2:
Mailing Address - City:ELKRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21075-7366
Mailing Address - Country:US
Mailing Address - Phone:443-975-0941
Mailing Address - Fax:
Practice Address - Street 1:43 SE MAIN ST STE 226
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55414-1094
Practice Address - Country:US
Practice Address - Phone:612-324-9001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-02
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD25319104100000X
MN29763104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker