1598055113 NPI number — KIMBERLY KATHERINE FITZGERALD MSW, LICSW

Table of content: KIMBERLY KATHERINE FITZGERALD MSW, LICSW (NPI 1598055113)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598055113 NPI number — KIMBERLY KATHERINE FITZGERALD MSW, LICSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FITZGERALD
Provider First Name:
KIMBERLY
Provider Middle Name:
KATHERINE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSW, LICSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ERNST
Provider Other First Name:
KIMBERLY
Provider Other Middle Name:
K
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
BSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1598055113
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/03/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1393
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOUTH YARMOUTH
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02664-7393
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-364-1182
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6 GRANITE STATE CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BREWSTER
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02631-2127
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-827-1220
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/15/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  000124707 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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