Provider Demographics
NPI:1568595726
Name:FITZGERALD, EUGENE (LCSW-R)
Entity Type:Individual
Prefix:
First Name:EUGENE
Middle Name:
Last Name:FITZGERALD
Suffix:
Gender:M
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 HOYT AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10301-2627
Mailing Address - Country:US
Mailing Address - Phone:718-727-9144
Mailing Address - Fax:
Practice Address - Street 1:3312 SURF AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11224-1406
Practice Address - Country:US
Practice Address - Phone:718-449-4000
Practice Address - Fax:718-372-7328
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR057023-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical