Provider Demographics
NPI:1881716207
Name:FITZGERALD, KELLY L (MA, LMHC)
Entity type:Individual
Prefix:MS
First Name:KELLY
Middle Name:L
Last Name:FITZGERALD
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:NORTH EASTON
Mailing Address - State:MA
Mailing Address - Zip Code:02357-0001
Mailing Address - Country:US
Mailing Address - Phone:508-565-1331
Mailing Address - Fax:508-565-1691
Practice Address - Street 1:320 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:NORTH EASTON
Practice Address - State:MA
Practice Address - Zip Code:02357-2717
Practice Address - Country:US
Practice Address - Phone:508-565-1331
Practice Address - Fax:508-565-1691
Is Sole Proprietor?:No
Enumeration Date:2007-04-05
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
MA6502101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)