Provider Demographics
NPI:1568101475
Name:FITZSIMMONS, LORELL LEIGH
Entity Type:Individual
Prefix:
First Name:LORELL
Middle Name:LEIGH
Last Name:FITZSIMMONS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 STATE ST
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12207-2005
Mailing Address - Country:US
Mailing Address - Phone:518-447-4820
Mailing Address - Fax:
Practice Address - Street 1:112 STATE ST
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12207-2005
Practice Address - Country:US
Practice Address - Phone:518-447-4820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-31
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY70762014OtherEARLY INTERVENTION