Provider Demographics
NPI:1467833798
Name:FITZGERALD, MATTHEW EDMOND (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:EDMOND
Last Name:FITZGERALD
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6801 OAK HALL LN # 2254
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-9998
Mailing Address - Country:US
Mailing Address - Phone:202-455-6124
Mailing Address - Fax:
Practice Address - Street 1:6801 OAK HALL LN # 2254
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-9998
Practice Address - Country:US
Practice Address - Phone:202-455-6124
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-11
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPSY1001067103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical