Provider Demographics
NPI:1235720517
Name:FITZGERALD, ANGELA (BSW)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:FITZGERALD
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5607 E STEAMBOAT BND
Mailing Address - Street 2:
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83854-7715
Mailing Address - Country:US
Mailing Address - Phone:208-964-2961
Mailing Address - Fax:
Practice Address - Street 1:5607 E STEAMBOAT BND
Practice Address - Street 2:
Practice Address - City:POST FALLS
Practice Address - State:ID
Practice Address - Zip Code:83854-7715
Practice Address - Country:US
Practice Address - Phone:208-964-2961
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-29
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician