Basic Information
| Provider Information | |||||||||
| NPI: | 1144748518 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FITZ-PATRICK | ||||||||
| FirstName: | TABITHA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1488 W LIBERTY ST | ||||||||
| Address2: | |||||||||
| City: | HUBBARD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 444253309 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1325 5TH AVE | ||||||||
| Address2: | |||||||||
| City: | YOUNGSTOWN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 445041702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3307431015 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/06/2017 | ||||||||
| LastUpdateDate: | 10/01/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/01/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | Y | Behavioral Health & Social Service Providers | Social Worker |
ID Information
| ID | Type | State | Issuer | Description | 0000000000 | 01 | OH | NONE | OTHER |