Provider Demographics
NPI:1669665717
Name:STEPHANIE M. FITZGERALD
Entity Type:Organization
Organization Name:STEPHANIE M. FITZGERALD
Other - Org Name:FITZGERALD & ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PSYCHIATRIC CLINICAL NURSE
Authorized Official - Prefix:MS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:FITZGERALD
Authorized Official - Suffix:
Authorized Official - Credentials:RN,MS,CS,PC
Authorized Official - Phone:978-744-8608
Mailing Address - Street 1:34 SUMMER ST
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-3317
Mailing Address - Country:US
Mailing Address - Phone:978-744-8608
Mailing Address - Fax:978-744-3702
Practice Address - Street 1:34 SUMMER ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-3317
Practice Address - Country:US
Practice Address - Phone:978-744-8608
Practice Address - Fax:978-744-3702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-22
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA117519101Y00000X, 101YM0800X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM15980Medicare PIN