Healthcare Provider Details

I. General information

NPI: 1013634500
Provider Name (Legal Business Name): JAMES FITZGERALD PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2022
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1022 22ND ST
SACRAMENTO CA
95816-4908
US

IV. Provider business mailing address

1022 22ND ST
SACRAMENTO CA
95816-4908
US

V. Phone/Fax

Practice location:
  • Phone: 916-284-1416
  • Fax: 916-405-3539
Mailing address:
  • Phone: 916-284-1416
  • Fax: 916-405-3539

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number36992
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: