Provider Demographics
NPI:1619560612
Name:FITZGERALD, SHAWNTEL (PSYCHOLOGY ASSOCIATE)
Entity Type:Individual
Prefix:
First Name:SHAWNTEL
Middle Name:
Last Name:FITZGERALD
Suffix:
Gender:F
Credentials:PSYCHOLOGY ASSOCIATE
Other - Prefix:
Other - First Name:SHAWNTEL
Other - Middle Name:
Other - Last Name:FITZGERALD LAMBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:20 CROSSROADS DR STE 105
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-5480
Mailing Address - Country:US
Mailing Address - Phone:410-356-2007
Mailing Address - Fax:
Practice Address - Street 1:20 CROSSROADS DR STE 105
Practice Address - Street 2:
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-5480
Practice Address - Country:US
Practice Address - Phone:410-356-2007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-19
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA0449101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health