Active NPI
Carol J Fitzpatrick, PHD
- Clinical Psychologist
- Santa Fe, NM
National Provider Identifier
1790710150
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 0769
- Practice address
- 1232 Apache Ave
Santa Fe, NM 87505-3255 - Phone
- (505) 424-9159
- Fax
- (505) 216-7595
- NPI assigned
- Jul 12, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 0769 | NM | Primary |
Addresses
Primary practice location
1232 Apache Ave
Santa Fe, NM 87505-3255
Mailing address
1800 Old Pecos TRL Ste B
Santa Fe, NM 87505-4787
Phone (505) 424-9159
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| NM600536 | Other | NM | VALUE OPTIONS |
| 201030542 | Other | NM | PRESBYTERIAN HEALTH PLAN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0769 | NM | MD | Hearing Instrument Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152662400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1270684800000",
"number": "1790710150",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1800 OLD PECOS TRL STE B",
"city": "SANTA FE",
"state": "NM",
"postal_code": "875054787",
"telephone_number": "505-424-9159",
"fax_number": "505-216-7595"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1232 APACHE AVE",
"city": "SANTA FE",
"state": "NM",
"postal_code": "875053255",
"telephone_number": "505-424-9159",
"fax_number": "505-216-7595"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FITZPATRICK",
"first_name": "CAROL",
"middle_name": "J",
"credential": "PHD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-07-12",
"last_updated": "2010-04-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NM",
"license": "0769",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "VALUE OPTIONS",
"identifier": "NM600536",
"state": "NM"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PRESBYTERIAN HEALTH PLAN",
"identifier": "201030542",
"state": "NM"
}
],
"endpoints": [],
"other_names": []
}Other providers in Santa Fe, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 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.