Provider Demographics
NPI:1881482206
Name:FITZGERALD, EMILY (CERT ASD SPECIALIST)
Entity type:Individual
Prefix:MS
First Name:EMILY
Middle Name:
Last Name:FITZGERALD
Suffix:
Gender:
Credentials:CERT ASD SPECIALIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1845 BANANA RD
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33810-2048
Mailing Address - Country:US
Mailing Address - Phone:863-255-0853
Mailing Address - Fax:
Practice Address - Street 1:1845 BANANA RD
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33810-2048
Practice Address - Country:US
Practice Address - Phone:863-255-0853
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-26
Last Update Date:2025-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCAS25229006171M00000X, 174400000X, 174H00000X, 103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No174400000XOther Service ProvidersSpecialist
No174H00000XOther Service ProvidersHealth Educator
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCAS25229006OtherIBCCES CERT. AUTISM SPECIALIST