Provider Demographics
NPI:1760780282
Name:FITZGERALD, KRISTEN T (MA)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:T
Last Name:FITZGERALD
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3657
Mailing Address - Street 2:
Mailing Address - City:LAKE WALES
Mailing Address - State:FL
Mailing Address - Zip Code:33859-3657
Mailing Address - Country:US
Mailing Address - Phone:863-589-3608
Mailing Address - Fax:
Practice Address - Street 1:802 N HOAGLAND BLVD
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-4518
Practice Address - Country:US
Practice Address - Phone:863-589-3608
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-08
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor