Provider Demographics
NPI:1639239510
Name:FITZGERALD, KAREN MARIE (PHD)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:MARIE
Last Name:FITZGERALD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7897 KENDRICK CT
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20112-4600
Mailing Address - Country:US
Mailing Address - Phone:703-791-3200
Mailing Address - Fax:
Practice Address - Street 1:2200 OPITZ BLVD
Practice Address - Street 2:SUITE 105B
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-3321
Practice Address - Country:US
Practice Address - Phone:703-491-0042
Practice Address - Fax:703-491-9200
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810003736103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical