Provider Demographics
NPI:1831165661
Name:FITZGIBBONS, LEE ANN (PHD)
Entity type:Individual
Prefix:DR
First Name:LEE
Middle Name:ANN
Last Name:FITZGIBBONS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MRS
Other - First Name:LEE
Other - Middle Name:FITZGIBBONS
Other - Last Name:STREET
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 70
Mailing Address - Street 2:
Mailing Address - City:RAYMOND
Mailing Address - State:ME
Mailing Address - Zip Code:04071-0070
Mailing Address - Country:US
Mailing Address - Phone:207-655-2737
Mailing Address - Fax:207-655-1065
Practice Address - Street 1:186 TWIN SPRING LANE
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:ME
Practice Address - Zip Code:04457
Practice Address - Country:US
Practice Address - Phone:207-655-2737
Practice Address - Fax:207-655-1065
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPS1176103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME061697OtherANTHEM BC/BS OF ME PIN