MEDICARE: MS. KELLY L FITZGERALD MA, LMHC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	101YM0800X	Mental Health Counselor	6502	MA

General Provider Information

NPI Number	:	1881716207
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KELLY L FITZGERALD MA, LMHC

Provider Business Mailing Address
First Line	:	320 WASHINGTON ST
Second Line	:
City	:	NORTH EASTON
State	:	MA
Zip	:	02357-0001
Country	:	US
Telephone Number	:	508-565-1331
Fax Number	:	508-565-1691

Provider Business Practice Location Address
First Line	:	320 WASHINGTON ST
Second Line	:
City	:	NORTH EASTON
State	:	MA
Zip	:	02357-2717
Country	:	US
Telephone Number	:	508-565-1331
Fax Number	:	508-565-1691

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

Provider Enumeration Date	:	04/05/2007
Last Update Date	:	09/14/2021

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