Provider Demographics
NPI:1104949585
Name:FITZGERALD, PAUL JOSEPH (PSYD, LCPC)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:JOSEPH
Last Name:FITZGERALD
Suffix:
Gender:M
Credentials:PSYD, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8031 42ND ST
Mailing Address - Street 2:
Mailing Address - City:LYONS
Mailing Address - State:IL
Mailing Address - Zip Code:60534-1101
Mailing Address - Country:US
Mailing Address - Phone:708-337-6936
Mailing Address - Fax:314-675-6788
Practice Address - Street 1:401 S LA SALLE ST
Practice Address - Street 2:SUITE 1600-P
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60605-1014
Practice Address - Country:US
Practice Address - Phone:708-337-6936
Practice Address - Fax:314-675-6788
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2014-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180-001119101YM0800X
IL071-008816103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health