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General NPI Number Information
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NPI Number | 1760037998
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Entity Type | Individual
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Provider Name | AMY B FITZGIBBON LICSW
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Gender | Female
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Dates
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Enumeration Date | 08/05/2019
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Last Update Date | 08/05/2019
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Provider Practice Location Address
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Address Line | 444 HOSMER ST
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City | MARLBOROUGH
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State | MA
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Zip | 01752-1434
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Country | US
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Telephone | 508-460-3506
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Fax |
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Provider Business Mailing Address
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Address Line | 59A FISHER ST
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City | WESTBOROUGH
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State | MA
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Zip | 01581-1806
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Country | US
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Telephone | 508-836-4044
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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 | 101YS0200X
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Taxonomy Name | School Counselor
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License Number | 110236-SW-LICSW
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License Number State | MA
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