Provider Demographics
NPI:1881830917
Name:FITZGERALD, CHRISTINE E (MA, MED, PHD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:E
Last Name:FITZGERALD
Suffix:
Gender:F
Credentials:MA, MED, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 S OAKLAND AVE
Mailing Address - Street 2:
Mailing Address - City:VILLA PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60181-3078
Mailing Address - Country:US
Mailing Address - Phone:630-774-3007
Mailing Address - Fax:
Practice Address - Street 1:720 S OAKLAND AVE
Practice Address - Street 2:
Practice Address - City:VILLA PARK
Practice Address - State:IL
Practice Address - Zip Code:60181-3078
Practice Address - Country:US
Practice Address - Phone:630-774-3007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-19
Last Update Date:2008-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.006310101YP2500X
IL1599773103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool