MEDICARE: MS. EMILY FITZGERALD CERT ASD SPECIALIST

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	171M00000X	Case Manager/Care Coordinator	CAS25229006	FL
2	174400000X	Specialist	CAS25229006	FL
3	174H00000X	Health Educator	CAS25229006	FL
4	103K00000X	Behavior Analyst	CAS25229006	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CAS25229006	OTHER	FL	IBCCES CERT. AUTISM SPECIALIST

General Provider Information

NPI Number	:	1881482206
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. EMILY FITZGERALD CERT ASD SPECIALIST

Provider Business Mailing Address
First Line	:	1845 BANANA RD
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33810-2048
Country	:	US
Telephone Number	:	863-255-0853
Fax Number	:

Provider Business Practice Location Address
First Line	:	1845 BANANA RD
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33810-2048
Country	:	US
Telephone Number	:	863-255-0853
Fax Number	:

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

Provider Enumeration Date	:	04/26/2025
Last Update Date	:	04/26/2025

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