Provider Demographics
NPI:1770714958
Name:FITZGERALD, ELIZABETH A (LCSW)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:A
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 1:2202 SW B AVE
Mailing Address - Street 2:APT. 511
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73501-4113
Mailing Address - Country:US
Mailing Address - Phone:808-222-9823
Mailing Address - Fax:
Practice Address - Street 1:2202 SW B AVE
Practice Address - Street 2:APT. 511
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73501-4113
Practice Address - Country:US
Practice Address - Phone:808-222-9823
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-05
Last Update Date:2009-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI35231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical