Provider Demographics
NPI:1154768067
Name:FITZGERALD, SULLIVAN MIDGE (LMSW)
Entity type:Individual
Prefix:
First Name:SULLIVAN
Middle Name:MIDGE
Last Name:FITZGERALD
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:MAUREEN
Other - Last Name:FITZGERALD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:PO BOX 980304
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48198-0304
Mailing Address - Country:US
Mailing Address - Phone:734-216-0417
Mailing Address - Fax:
Practice Address - Street 1:300 N 5TH AVE STE 230
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-5504
Practice Address - Country:US
Practice Address - Phone:734-216-0417
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-31
Last Update Date:2022-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010955691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical