Provider Demographics
NPI:1396863296
Name:FITZSIMMONS, BRIAN P (LCSW-C)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:P
Last Name:FITZSIMMONS
Suffix:
Gender:M
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 KILLADOON CT
Mailing Address - Street 2:
Mailing Address - City:TIMONIUM
Mailing Address - State:MD
Mailing Address - Zip Code:21093-1936
Mailing Address - Country:US
Mailing Address - Phone:410-561-5126
Mailing Address - Fax:
Practice Address - Street 1:18 KILLADOON CT
Practice Address - Street 2:
Practice Address - City:TIMONIUM
Practice Address - State:MD
Practice Address - Zip Code:21093-1936
Practice Address - Country:US
Practice Address - Phone:410-561-5126
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD114641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical