Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | SW132874 | PA |
NPI | 1003343195 |
---|---|
Provider Name | Angie Lynn Fitzgerald |
First Address | Mechanicsburg, PA 17055-6422 |
Second Address | Mechanicsburg, PA 17055-4530 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2017 |
Last Update Date | 19/05/2017 |