Provider Demographics
NPI:1255447173
Name:FITZGERALD, CHERYL DAWN (LCSW)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:DAWN
Last Name:FITZGERALD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15719 AMADOR RIO
Mailing Address - Street 2:
Mailing Address - City:HELOTES
Mailing Address - State:TX
Mailing Address - Zip Code:78023-3682
Mailing Address - Country:US
Mailing Address - Phone:210-896-3771
Mailing Address - Fax:
Practice Address - Street 1:15719 AMADOR RIO
Practice Address - Street 2:
Practice Address - City:HELOTES
Practice Address - State:TX
Practice Address - Zip Code:78023-3682
Practice Address - Country:US
Practice Address - Phone:210-896-3771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX338171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical