Provider Demographics
NPI:1538700976
Name:FITZGERALD, ASHLEY (MSW)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:FITZGERALD
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 S 108TH PL
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85208-7601
Mailing Address - Country:US
Mailing Address - Phone:480-603-5565
Mailing Address - Fax:
Practice Address - Street 1:4650 E COTTON CENTER BLVD STE 250
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85040-4806
Practice Address - Country:US
Practice Address - Phone:602-633-1828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-07
Last Update Date:2019-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical