Provider Demographics
NPI:1174256762
Name:FITZGERALD, KIMBERLLY
Entity Type:Individual
Prefix:
First Name:KIMBERLLY
Middle Name:
Last Name:FITZGERALD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 MORGAN RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:NH
Mailing Address - Zip Code:03470-4907
Mailing Address - Country:US
Mailing Address - Phone:603-313-9265
Mailing Address - Fax:
Practice Address - Street 1:348 MATTHEWS RD
Practice Address - Street 2:
Practice Address - City:SWANZEY
Practice Address - State:NH
Practice Address - Zip Code:03446-3500
Practice Address - Country:US
Practice Address - Phone:603-488-5008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-01
Last Update Date:2022-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician