Provider Demographics
NPI:1912188582
Name:FITZGERALD, ANDREW L (PHD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:L
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 1:13575 W INDIAN SCHOOL RD STE 500
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD PARK
Mailing Address - State:AZ
Mailing Address - Zip Code:85340-4903
Mailing Address - Country:US
Mailing Address - Phone:623-312-3713
Mailing Address - Fax:623-328-9352
Practice Address - Street 1:13575 W INDIAN SCHOOL RD STE 500
Practice Address - Street 2:
Practice Address - City:LITCHFIELD PARK
Practice Address - State:AZ
Practice Address - Zip Code:85340-4903
Practice Address - Country:US
Practice Address - Phone:623-312-3713
Practice Address - Fax:623-328-9352
Is Sole Proprietor?:No
Enumeration Date:2007-11-23
Last Update Date:2018-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ101YS0200X
AZ4951103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool