Provider Demographics
NPI:1598055113
Name:FITZGERALD, KIMBERLY KATHERINE (MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:KATHERINE
Last Name:FITZGERALD
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:K
Other - Last Name:ERNST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BSW
Mailing Address - Street 1:PO BOX 1393
Mailing Address - Street 2:
Mailing Address - City:SOUTH YARMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02664-7393
Mailing Address - Country:US
Mailing Address - Phone:508-364-1182
Mailing Address - Fax:
Practice Address - Street 1:6 GRANITE STATE CT
Practice Address - Street 2:
Practice Address - City:BREWSTER
Practice Address - State:MA
Practice Address - Zip Code:02631-2127
Practice Address - Country:US
Practice Address - Phone:508-827-1220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-15
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA0001247071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical