Provider Demographics
NPI:1043424211
Name:FITZGERALD, JULIE ANNE (PC)
Entity Type:Individual
Prefix:MISS
First Name:JULIE
Middle Name:ANNE
Last Name:FITZGERALD
Suffix:
Gender:F
Credentials:PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 HIGH ST NE
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44481-1222
Mailing Address - Country:US
Mailing Address - Phone:330-394-9090
Mailing Address - Fax:330-394-8163
Practice Address - Street 1:320 HIGH ST NE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44481-1222
Practice Address - Country:US
Practice Address - Phone:330-394-9090
Practice Address - Fax:330-394-8163
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC0600102101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional