Provider Demographics
NPI:1386876910
Name:FITZGERALD, CAROLE ANN (BA, FL-CBA)
Entity type:Individual
Prefix:
First Name:CAROLE
Middle Name:ANN
Last Name:FITZGERALD
Suffix:
Gender:F
Credentials:BA, FL-CBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5586 LIGUSTRUM LOOP
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-7996
Mailing Address - Country:US
Mailing Address - Phone:407-359-1240
Mailing Address - Fax:
Practice Address - Street 1:4541 ALRIX DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32839-3160
Practice Address - Country:US
Practice Address - Phone:407-489-2121
Practice Address - Fax:407-382-2458
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-15
Last Update Date:2009-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0217103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst