Provider Demographics
NPI:1619052024
Name:FITZGERALD, JILL W (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JILL
Middle Name:W
Last Name:FITZGERALD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17512 BURTONWOOD PL
Mailing Address - Street 2:
Mailing Address - City:MOSELEY
Mailing Address - State:VA
Mailing Address - Zip Code:23120-2256
Mailing Address - Country:US
Mailing Address - Phone:804-357-6966
Mailing Address - Fax:
Practice Address - Street 1:9327 MIDLOTHIAN TPKE STE 2G
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23235-4944
Practice Address - Country:US
Practice Address - Phone:804-257-9348
Practice Address - Fax:804-608-9850
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0904001274104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker