Provider Demographics
NPI:1427694546
Name:FITZGERALD, GERARD (LCPC)
Entity type:Individual
Prefix:
First Name:GERARD
Middle Name:
Last Name:FITZGERALD
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 COOPERS MILLS RD
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:ME
Mailing Address - Zip Code:04363-3825
Mailing Address - Country:US
Mailing Address - Phone:207-549-3680
Mailing Address - Fax:
Practice Address - Street 1:303 COOPERS MILLS RD
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:ME
Practice Address - Zip Code:04363-3825
Practice Address - Country:US
Practice Address - Phone:207-549-3680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-24
Last Update Date:2019-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEXL5367101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional