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NPI Code Detail

MEDICARE: MARY FITZGERALD LICSW

MEDICARE: MARY FITZGERALD LICSW
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
11041C0700XClinical Social Worker10455MD

General Provider Information

NPI Number : 1902000474
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY FITZGERALD LICSW
Provider Business Mailing Address
First Line : 5480 WISCONSIN AVE STE 225
Second Line :
City : CHEVY CHASE
State : MD
Zip : 20815-3503
Country : US
Telephone Number : 202-236-2160
Fax Number :
Provider Business Practice Location Address
First Line : 5480 WISCONSIN AVE STE 225
Second Line :
City : CHEVY CHASE
State : MD
Zip : 20815-3503
Country : US
Telephone Number : 202-236-2160
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/11/2007
Last Update Date : 11/15/2018

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Directions to “ MARY FITZGERALD LICSW” Practice Location

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