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General NPI Number Information
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NPI Number | 1497116461
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Entity Type | Organization
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Legal Business Name | KATHLEEN B. FITZGERALD
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Dates
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Enumeration Date | 03/17/2016
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Last Update Date | 08/12/2016
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Provider Practice Location Address
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Address Line | 111 EAST AVE SUITE 313
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City | NORWALK
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State | CT
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Zip | 06851-5014
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Country | US
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Telephone | 203-247-0342
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Fax |
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Provider Business Mailing Address
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Address Line | 115 GODFREY RD E
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City | WESTON
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State | CT
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Zip | 06883-1403
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KATHLEEN FITZGERALD
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Credential |
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Telephone | 203-247-0342
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 001600
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License Number State | CT
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