Fitzgerald, Maryellen
Fitzgerald, Maryellen is an individual health care provider with primary practice located at 135 Granger St , Rutland VT 05701-4405. She recently has only one registered license in Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder), which is considered as her primary health care specialty. Fitzgerald, Maryellen can be contacted via phone (802) 775-8224.Contact Information
Primary practice address
135 Granger St
Rutland VT 05701-4405
Phone: (802) 775-8224
Fax: (802) 747-7699
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) | 101YA0400X | 000592 | Vermont |
Profile Details
| NPI number | 1669813317 |
|---|---|
| LBN Legal business name | Fitzgerald, Maryellen |
| Credentials | LADC |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jul 10th, 2013 |
| Last updated | Jul 10th, 2013 - about 13 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1669813317 | NPPES |
| Vermont | Other | 000592 | LADC LICENSE |
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