MEDICARE: MS. CHRISTINA MARIA FITZSIMMONS LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	44SC05277500	NJ

General Provider Information

NPI Number	:	1073783957
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CHRISTINA MARIA FITZSIMMONS LCSW

Provider Business Mailing Address
First Line	:	1450 PALISADE AVE
Second Line	:	APT. 1-I
City	:	FORT LEE
State	:	NJ
Zip	:	07024-5212
Country	:	US
Telephone Number	:	201-917-5369
Fax Number	:

Provider Business Practice Location Address
First Line	:	20 WILSEY SQ
Second Line	:	SUITE C
City	:	RIDGEWOOD
State	:	NJ
Zip	:	07450-3793
Country	:	US
Telephone Number	:	201-445-1068
Fax Number	:	201-445-7995

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/06/2008
Last Update Date	:	03/06/2008

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