Provider Demographics
NPI:1972744803
Name:FITZGERALD, MARTHA FRANCES (LPC)
Entity type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:FRANCES
Last Name:FITZGERALD
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MRS
Other - First Name:MARTHA
Other - Middle Name:F
Other - Last Name:HUEBNER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:20 NICHOLAS RD
Mailing Address - Street 2:
Mailing Address - City:HOPKINTON
Mailing Address - State:MA
Mailing Address - Zip Code:01748-2406
Mailing Address - Country:US
Mailing Address - Phone:508-435-2656
Mailing Address - Fax:
Practice Address - Street 1:20 NICHOLAS RD
Practice Address - Street 2:
Practice Address - City:HOPKINTON
Practice Address - State:MA
Practice Address - Zip Code:01748-2406
Practice Address - Country:US
Practice Address - Phone:508-435-2656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-24
Last Update Date:2009-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000096101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT000096OtherLICENSED PROFESSIONAL COUNSELOR
36941OtherNATIONAL CERTIFIED COUNSELOR