Healthcare Provider Details

I. General information

NPI: 1043121700
Provider Name (Legal Business Name): TARYN ROSANO FITZGERALD PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81 HARTWELL AVE STE 310
LEXINGTON MA
02421-3177
US

IV. Provider business mailing address

2 REPTON PL APT 2101
WATERTOWN MA
02472-2455
US

V. Phone/Fax

Practice location:
  • Phone: 781-918-6860
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS02457
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: