Healthcare Provider Details

I. General information

NPI: 1447366026
Provider Name (Legal Business Name): JENNIFER FITZGERALD EICH LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER THERESE FITZGERALD LCSW

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23461 S POINTE DR STE 260
LAGUNA HILLS CA
92653-1573
US

IV. Provider business mailing address

23461 S POINTE DR STE 260
LAGUNA HILLS CA
92653-1573
US

V. Phone/Fax

Practice location:
  • Phone: 949-855-1556
  • Fax:
Mailing address:
  • Phone: 949-855-1556
  • Fax: 949-633-0458

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW24943
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: