MEDICARE: MICHELLE FITZGERALD LICSW, LCSW, MSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	0904008422	VA
2	1041C0700X	Clinical Social Worker	LC50079879	DC

General Provider Information

NPI Number	:	1326471921
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE FITZGERALD LICSW, LCSW, MSW

Provider Business Mailing Address
First Line	:	35953 PAXSON RD
Second Line	:
City	:	PURCELLVILLE
State	:	VA
Zip	:	20132-3839
Country	:	US
Telephone Number	:	202-905-7278
Fax Number	:

Provider Business Practice Location Address
First Line	:	1220 N FILLMORE ST STE 345
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22201-6501
Country	:	US
Telephone Number	:	202-905-7278
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/19/2013
Last Update Date	:	12/31/2025

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