Provider Demographics
NPI:1538222716
Name:FITZGERALD, ANN BERGAN (LICSW)
Entity type:Individual
Prefix:MRS
First Name:ANN
Middle Name:BERGAN
Last Name:FITZGERALD
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MS
Other - First Name:ANN
Other - Middle Name:GRETCHEN
Other - Last Name:BERGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:173 CHELSEA ST
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:MA
Mailing Address - Zip Code:02149
Mailing Address - Country:US
Mailing Address - Phone:781-861-0890
Mailing Address - Fax:
Practice Address - Street 1:10 CABOT RD FL 1
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155-5177
Practice Address - Country:US
Practice Address - Phone:781-393-5152
Practice Address - Fax:781-393-5168
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2015-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1106241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1538222716OtherUBH
MA1518164508OtherFALLON COMMUNITY HEALTH PLAN
MA12515715OtherMULTI-PLAN
MA1518164508OtherMEDICARE
MA1518164508OtherMBHP
MA1518164508OtherBLUE CROSS/BLUE SHIELD
MA486325OtherVALUE OPTIONS
MA9186232OtherPHCS
MA987309-02OtherNETWORK HEALTH