Provider Demographics
NPI:1114696952
Name:FITZGERALD, SEAN (MT-BC)
Entity type:Individual
Prefix:
First Name:SEAN
Middle Name:
Last Name:FITZGERALD
Suffix:
Gender:M
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 SUMMER ST
Mailing Address - Street 2:
Mailing Address - City:HAVERHILL
Mailing Address - State:MA
Mailing Address - Zip Code:01830-6032
Mailing Address - Country:US
Mailing Address - Phone:978-373-7010
Mailing Address - Fax:
Practice Address - Street 1:116 SUMMER ST
Practice Address - Street 2:
Practice Address - City:HAVERHILL
Practice Address - State:MA
Practice Address - Zip Code:01830-6032
Practice Address - Country:US
Practice Address - Phone:978-373-7010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-07
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
16799225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist