Provider Demographics
NPI:1497156871
Name:FITZGERALD, EMILY (LMSW)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:FITZGERALD
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3694 CLARKSTON RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48348-5213
Mailing Address - Country:US
Mailing Address - Phone:248-693-8880
Mailing Address - Fax:248-391-7478
Practice Address - Street 1:705 S MAIN ST
Practice Address - Street 2:SUITE 280
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-2089
Practice Address - Country:US
Practice Address - Phone:734-454-3560
Practice Address - Fax:734-454-3570
Is Sole Proprietor?:No
Enumeration Date:2014-09-04
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010968101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical