Provider Demographics
NPI:1356583934
Name:FITZSIMONS, LAURAJANE LECLAIR (MED, CAGS, LMHC)
Entity type:Individual
Prefix:MS
First Name:LAURAJANE
Middle Name:LECLAIR
Last Name:FITZSIMONS
Suffix:
Gender:F
Credentials:MED, CAGS, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 RIVERVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:SWANSEA
Mailing Address - State:MA
Mailing Address - Zip Code:02777-2814
Mailing Address - Country:US
Mailing Address - Phone:508-675-1735
Mailing Address - Fax:
Practice Address - Street 1:285 OLD WESTPORT RD
Practice Address - Street 2:COUNSELING CENTER
Practice Address - City:N DARTMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02747-2356
Practice Address - Country:US
Practice Address - Phone:508-999-8650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-30
Last Update Date:2009-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6946101YP2500X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty