Individual provider Active NPI

Julia Heather Fitzpatrick, LCSW

  • Clinical Social Worker
  • Coronado, CA
National Provider Identifier
1558412411
Registry record updated Oct 12, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
LCSW 28929 Issued in CA
Practice address
158 C Avenue
Coronado, CA 92118-3114
Phone
(619) 602-4598
Fax
(619) 435-4501
NPI assigned
Jan 16, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 12, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X LCSW 28929 CA Primary

Addresses

Primary practice location

158 C Avenue
Coronado, CA 92118-3114

Mailing address

899 Main St Ste 1
Colchester, VT 05446-4420
Phone (866) 284-2771

Other practice location 1

899 Main St Ste 1
Colchester, VT 05446-4420
Phone (619) 602-4598

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA, VT2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20161129000518 CA Practitioner - Clinical Social Worker 0244312643 Practice locations: Coronado, CA
I20200526001597 VT Practitioner - Clinical Social Worker 0244312643 Practice locations: Colchester, VT

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

899 Main St
Suite 1
Colchester, VT 05446-4420
Phone (619) 602-4598

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
LCSW 28929CAMDClinical Social Worker

NPI Registry JSON

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

{
    "created_epoch": "1168905600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1602460800000",
    "number": "1558412411",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "899 MAIN ST STE 1",
            "city": "COLCHESTER",
            "state": "VT",
            "postal_code": "054464420",
            "telephone_number": "866-284-2771",
            "fax_number": "619-435-4501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "158 C AVENUE",
            "city": "CORONADO",
            "state": "CA",
            "postal_code": "921183114",
            "telephone_number": "619-602-4598",
            "fax_number": "619-435-4501"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "899 Main St Ste 1",
            "address_purpose": "LOCATION",
            "city": "Colchester",
            "state": "VT",
            "postal_code": "054464420",
            "country_code": "US",
            "telephone_number": "619-602-4598",
            "fax_number": "619-923-2400",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FITZPATRICK",
        "first_name": "JULIA",
        "middle_name": "HEATHER",
        "name_prefix": "Mrs.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-01-16",
        "last_updated": "2020-10-12",
        "certification_date": "2020-10-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "LCSW 28929",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Coronado, CA

Sources for this page

Verify at the official NPI Registry.