Basic Information
| Provider Information | |||||||||
| NPI: | 1639432503 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FITZPATRICK | ||||||||
| FirstName: | AMY | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | MSW, PCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1020 S CONWELL ST | ||||||||
| Address2: | |||||||||
| City: | CASPER | ||||||||
| State: | WY | ||||||||
| PostalCode: | 826013921 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1020 S CONWELL ST | ||||||||
| Address2: | |||||||||
| City: | CASPER | ||||||||
| State: | WY | ||||||||
| PostalCode: | 826013921 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3072336000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/16/2012 | ||||||||
| LastUpdateDate: | 07/16/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | PCSW 430 | WY | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.