Provider Demographics
NPI:1891587846
Name:FITZGIBBON, MICHELLE IRENE (LCSW, LMHP)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:IRENE
Last Name:FITZGIBBON
Suffix:
Gender:F
Credentials:LCSW, LMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20861 S PLZ
Mailing Address - Street 2:
Mailing Address - City:ELKHORN
Mailing Address - State:NE
Mailing Address - Zip Code:68022-4448
Mailing Address - Country:US
Mailing Address - Phone:308-379-8750
Mailing Address - Fax:
Practice Address - Street 1:20861 S PLZ
Practice Address - Street 2:
Practice Address - City:ELKHORN
Practice Address - State:NE
Practice Address - Zip Code:68022-4448
Practice Address - Country:US
Practice Address - Phone:308-379-8750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-17
Last Update Date:2025-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1510104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker