Healthcare Provider Details

I. General information

NPI: 1427694546
Provider Name (Legal Business Name): GERARD FITZGERALD LCPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/24/2019
Last Update Date: 11/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 COOPERS MILLS RD
WINDSOR ME
04363-3825
US

IV. Provider business mailing address

303 COOPERS MILLS RD
WINDSOR ME
04363-3825
US

V. Phone/Fax

Practice location:
  • Phone: 207-549-3680
  • Fax:
Mailing address:
  • Phone: 207-549-3680
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberXL5367
License Number StateME

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: