Provider Demographics
NPI:1073645305
Name:FITZGERALD, PAULA ELAINE (LMFT)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:ELAINE
Last Name:FITZGERALD
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:PAULA
Other - Middle Name:
Other - Last Name:FIELDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MFT
Mailing Address - Street 1:4526 NE 40TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97211-8133
Mailing Address - Country:US
Mailing Address - Phone:209-988-8816
Mailing Address - Fax:
Practice Address - Street 1:2926 NE FLANDERS ST STE 1A
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-3259
Practice Address - Country:US
Practice Address - Phone:209-988-8816
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001075-01106H00000X
CA39823106H00000X
CAMFC39823106H00000X
ORT1674106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist