MEDICARE: MS. JILL W FITZGERALD 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	104100000X	Social Worker	0904001274	VA

General Provider Information

NPI Number	:	1619052024
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JILL W FITZGERALD LCSW

Provider Business Mailing Address
First Line	:	17512 BURTONWOOD PL
Second Line	:
City	:	MOSELEY
State	:	VA
Zip	:	23120-2256
Country	:	US
Telephone Number	:	804-357-6966
Fax Number	:

Provider Business Practice Location Address
First Line	:	9327 MIDLOTHIAN TPKE STE 2G
Second Line	:
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23235-4944
Country	:	US
Telephone Number	:	804-257-9348
Fax Number	:	804-608-9850

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

Provider Enumeration Date	:	10/25/2006
Last Update Date	:	03/31/2023

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