Phillip David Fitzpatrick, LCSW

Primary specialty

Social WorkerTaxonomy code 104100000X

License

16268 Issued in TX

Practice address

6600 Sanger Ave
Suite # 9
Waco, TX 76710-7814

Phone

(254) 722-6247

NPI assigned

Feb 12, 2007

Last updated

Dec 9, 2010By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1171238400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1291852800000",
    "number": "1538201322",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "615 HARVEST LN",
            "city": "MC GREGOR",
            "state": "TX",
            "postal_code": "766579713",
            "telephone_number": "254-722-6247"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6600 SANGER AVE",
            "address_2": "SUITE # 9",
            "city": "WACO",
            "state": "TX",
            "postal_code": "767107814",
            "telephone_number": "254-722-6247"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FITZPATRICK",
        "first_name": "PHILLIP",
        "middle_name": "DAVID",
        "name_prefix": "Mr.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-12",
        "last_updated": "2010-12-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "TX",
            "license": "16268",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "103097504",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Social Worker in Waco, TX
• Providers in Waco, TX by specialty
• Social Worker in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.