Provider Demographics
NPI:1891389474
Name:FITZGERALD, EILEEN FRANCES (PHD)
Entity Type:Individual
Prefix:DR
First Name:EILEEN
Middle Name:FRANCES
Last Name:FITZGERALD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 BARNES RD
Mailing Address - Street 2:
Mailing Address - City:FALLS VILLAGE
Mailing Address - State:CT
Mailing Address - Zip Code:06031-1213
Mailing Address - Country:US
Mailing Address - Phone:917-971-6068
Mailing Address - Fax:
Practice Address - Street 1:127 WEST 79TH STREET
Practice Address - Street 2:SUITE 5
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024
Practice Address - Country:US
Practice Address - Phone:212-799-3766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-24
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010389103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent