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General NPI Number Information
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NPI Number | 1538222716
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Entity Type | Individual
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Provider Name | ANN BERGAN FITZGERALD LICSW
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Gender | Female
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Dates
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Enumeration Date | 12/18/2006
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Last Update Date | 11/20/2015
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Provider Practice Location Address
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Address Line | 10 CABOT RD FL 1
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City | MEDFORD
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State | MA
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Zip | 02155-5177
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Country | US
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Telephone | 781-393-5152
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Fax | 781-393-5168
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Provider Business Mailing Address
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Address Line | 173 CHELSEA ST
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City | EVERETT
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State | MA
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Zip | 02149
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Country | US
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Telephone | 781-861-0890
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Fax |
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 110624
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License Number State | MA
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