Provider Demographics
NPI:1912974106
Name:FITZGERALD, STEPHEN GERARD (PHD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:GERARD
Last Name:FITZGERALD
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9912 LITTLE RD
Mailing Address - Street 2:VA OPC PASCO
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34654-3419
Mailing Address - Country:US
Mailing Address - Phone:727-869-4243
Mailing Address - Fax:727-869-4194
Practice Address - Street 1:9912 LITTLE RD
Practice Address - Street 2:VA OPC PASCO
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34654-3419
Practice Address - Country:US
Practice Address - Phone:727-869-4243
Practice Address - Fax:727-869-4194
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY3727103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical