Provider Demographics
NPI:1760520944
Name:FITZGERALD, WARREN D (PHD)
Entity Type:Individual
Prefix:DR
First Name:WARREN
Middle Name:D
Last Name:FITZGERALD
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-3622
Mailing Address - Country:US
Mailing Address - Phone:603-224-5140
Mailing Address - Fax:603-224-8070
Practice Address - Street 1:54 S STATE ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-3622
Practice Address - Country:US
Practice Address - Phone:603-224-5140
Practice Address - Fax:603-224-8070
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHAD003482103TA0400X
NH133103TA0700X, 103TB0200X, 103TC0700X, 103TC2200X, 103T00000X, 103TF0000X, 103TH0100X
NH22111103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH80622846Medicaid
NH80622846Medicaid