Provider Demographics
NPI:1063622694
Name:FITZGERALD, KYRIAKI ANTONIA (MDIV, PHD)
Entity type:Individual
Prefix:DR
First Name:KYRIAKI
Middle Name:ANTONIA
Last Name:FITZGERALD
Suffix:
Gender:F
Credentials:MDIV, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 477
Mailing Address - Street 2:
Mailing Address - City:SAGAMORE
Mailing Address - State:MA
Mailing Address - Zip Code:02561-0477
Mailing Address - Country:US
Mailing Address - Phone:508-888-8885
Mailing Address - Fax:
Practice Address - Street 1:90 RTE 6A
Practice Address - Street 2:SUITE 4C
Practice Address - City:SANDWICH
Practice Address - State:MA
Practice Address - Zip Code:02563
Practice Address - Country:US
Practice Address - Phone:508-888-8885
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5011103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist