Healthcare Provider Details

I. General information

NPI: 1356583934
Provider Name (Legal Business Name): LAURAJANE LECLAIR FITZSIMONS M.ED, C.A.G.S., LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2009
Last Update Date: 03/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

285 OLD WESTPORT RD COUNSELING CENTER
N DARTMOUTH MA
02747-2356
US

IV. Provider business mailing address

49 RIVERVIEW AVE
SWANSEA MA
02777-2814
US

V. Phone/Fax

Practice location:
  • Phone: 508-999-8650
  • Fax:
Mailing address:
  • Phone: 508-675-1735
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6946
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number6946
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: