Provider Demographics
NPI:1528536752
Name:FITZGERALD, MEGAN HART (LMHC)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:HART
Last Name:FITZGERALD
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 MAIN ST STE 201
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14094-3662
Mailing Address - Country:US
Mailing Address - Phone:716-433-3846
Mailing Address - Fax:
Practice Address - Street 1:41 MAIN ST STE 201
Practice Address - Street 2:
Practice Address - City:LOCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14094-3662
Practice Address - Country:US
Practice Address - Phone:716-433-3846
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-06
Last Update Date:2018-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009122101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health