Provider Demographics
NPI:1346929858
Name:FITZGERALD, JANEL MARIE (MS, BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:JANEL
Middle Name:MARIE
Last Name:FITZGERALD
Suffix:
Gender:F
Credentials:MS, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 FAIRMOUNT DRIVE
Mailing Address - Street 2:UNIT B
Mailing Address - City:MONROE
Mailing Address - State:CT
Mailing Address - Zip Code:06468-4873
Mailing Address - Country:US
Mailing Address - Phone:203-515-2286
Mailing Address - Fax:
Practice Address - Street 1:187 HALF MILE RD
Practice Address - Street 2:
Practice Address - City:NORTH HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06473-4121
Practice Address - Country:US
Practice Address - Phone:203-239-6425
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-12
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1680103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst