Provider Demographics
NPI:1447381272
Name:FITZGERALD, MEGAN M (MSW, PLCSW)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:M
Last Name:FITZGERALD
Suffix:
Gender:F
Credentials:MSW, PLCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7711 THETFORD CT
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63119-5064
Mailing Address - Country:US
Mailing Address - Phone:573-424-7987
Mailing Address - Fax:314-535-3003
Practice Address - Street 1:8730 MARVISTA DR
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63114-4308
Practice Address - Country:US
Practice Address - Phone:573-424-7987
Practice Address - Fax:314-535-0756
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005039201104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker