Provider Demographics
NPI:1861635542
Name:FITZGERALD, BRENNAN LAWRENCE (LPC)
Entity Type:Individual
Prefix:MS
First Name:BRENNAN
Middle Name:LAWRENCE
Last Name:FITZGERALD
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 BRINSCALL CT
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-5155
Mailing Address - Country:US
Mailing Address - Phone:616-676-6414
Mailing Address - Fax:
Practice Address - Street 1:8 DELAY ST
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-6654
Practice Address - Country:US
Practice Address - Phone:203-797-8330
Practice Address - Fax:203-798-8410
Is Sole Proprietor?:No
Enumeration Date:2009-04-11
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2616101YP2500X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program