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General NPI Number Information
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NPI Number | 1104949585
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Entity Type | Individual
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Provider Name | PAUL JOSEPH FITZGERALD PSY.D., LCPC
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Gender | Male
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Dates
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Enumeration Date | 04/09/2007
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Last Update Date | 05/19/2014
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Provider Practice Location Address
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Address Line | 401 S LA SALLE ST SUITE 1600-P
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City | CHICAGO
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State | IL
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Zip | 60605-1014
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Country | US
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Telephone | 708-337-6936
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Fax | 314-675-6788
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Provider Business Mailing Address
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Address Line | 8031 42ND ST
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City | LYONS
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State | IL
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Zip | 60534-1101
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Country | US
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Telephone | 708-337-6936
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Fax | 314-675-6788
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 180-001119
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 071-008816
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License Number State | IL
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