Healthcare Provider Details

I. General information

NPI: 1710654397
Provider Name (Legal Business Name): EMILY C FITZGERALD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2021
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 CHANLON RD
NEW PROVIDENCE NJ
07974-1543
US

IV. Provider business mailing address

131 CENTER ST
HIGHTSTOWN NJ
08520-4229
US

V. Phone/Fax

Practice location:
  • Phone: 973-299-9954
  • Fax:
Mailing address:
  • Phone: 609-216-8214
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number37PC01102600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: