Provider Demographics
NPI:1528546447
Name:WARREN D. FITZGERALD PHD PA
Entity Type:Organization
Organization Name:WARREN D. FITZGERALD PHD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WARREN
Authorized Official - Middle Name:D
Authorized Official - Last Name:FITZGERALD
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:603-224-5140
Mailing Address - Street 1:54 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-3705
Mailing Address - Country:US
Mailing Address - Phone:603-224-5140
Mailing Address - Fax:603-224-8070
Practice Address - Street 1:54 S STATE ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-3705
Practice Address - Country:US
Practice Address - Phone:603-224-5140
Practice Address - Fax:603-224-8070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-02
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0133103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty