Healthcare Provider Details

I. General information

NPI: 1053215269
Provider Name (Legal Business Name): HAYLEY FITZGERALD, LCSW
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2026
Last Update Date: 10/03/2026
Certification Date: 10/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 2ND ST
LISBON FALLS ME
04252-1614
US

IV. Provider business mailing address

6 2ND ST
LISBON FALLS ME
04252-1614
US

V. Phone/Fax

Practice location:
  • Phone: 207-242-2195
  • Fax:
Mailing address:
  • Phone: 207-242-2195
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name: HAYLEY FITZGERALD
Title or Position: LICENSED CLINICAL SOCIAL WORKER
Credential: LCSW
Phone: 207-242-2195