Provider Demographics
NPI:1720235583
Name:FITZGERALD, JENNIFER (MS)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:
Last Name:FITZGERALD
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 3 BOX 1322
Mailing Address - Street 2:
Mailing Address - City:PAHOA
Mailing Address - State:HI
Mailing Address - Zip Code:96778-7520
Mailing Address - Country:US
Mailing Address - Phone:808-965-2036
Mailing Address - Fax:
Practice Address - Street 1:RR 3 BOX 1322
Practice Address - Street 2:
Practice Address - City:PAHOA
Practice Address - State:HI
Practice Address - Zip Code:96778-7520
Practice Address - Country:US
Practice Address - Phone:808-965-2036
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-24
Last Update Date:2008-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health