Provider Demographics
NPI:1760037998
Name:FITZGIBBON, AMY B (LICSW)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:B
Last Name:FITZGIBBON
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:BLANCHETTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:59A FISHER ST
Mailing Address - Street 2:
Mailing Address - City:WESTBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01581-1806
Mailing Address - Country:US
Mailing Address - Phone:508-836-4044
Mailing Address - Fax:
Practice Address - Street 1:444 HOSMER ST
Practice Address - Street 2:
Practice Address - City:MARLBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01752-1434
Practice Address - Country:US
Practice Address - Phone:508-460-3506
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-05
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA110236-SW-LICSW101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool