Provider Demographics
NPI:1922073097
Name:FITZGERALD, MICHAEL DAVID (LCSW)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:DAVID
Last Name:FITZGERALD
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6086 7TH PL
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32968-9502
Mailing Address - Country:US
Mailing Address - Phone:772-778-7803
Mailing Address - Fax:
Practice Address - Street 1:2501 27TH AVE
Practice Address - Street 2:SUITE A-2
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-1960
Practice Address - Country:US
Practice Address - Phone:772-563-2644
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW12021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ2082OtherBS/BS