Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | ||
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 10427 | MA |
Y | 103G00000X | Clinical Psychologist | 10427 | MA |
Y | 103TC0700X | Clinical Psychologist | 10427 | MA |
N | 103TP2701X | Group Psychotherapist | 10427 | MA |
NPI | 1659636496 |
---|---|
Provider Name | Dr. William Eugene Fitzgerald |
First Address | Quincy, MA 02169-4339 |
Second Address | Quincy, MA 02169-4339 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/07/2012 |
Last Update Date | 09/09/2016 |