Provider Demographics
NPI:1932792090
Name:FITZGERALD, REBECCA MARTINEZ
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:MARTINEZ
Last Name:FITZGERALD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3326 DURHAM-CHAPEL HILL BOULEVARD
Mailing Address - Street 2:B-130
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707
Mailing Address - Country:US
Mailing Address - Phone:973-945-7038
Mailing Address - Fax:
Practice Address - Street 1:3326 DURHAM-CHAPEL HILL BOULEVARD
Practice Address - Street 2:B-130
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707
Practice Address - Country:US
Practice Address - Phone:973-945-7038
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-18
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical