Individual
DENISE MARY FITZGERALD
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
2205 PHYLLIS ST, BENTONVILLE, AR 72712-6490
(479) 750-2020
(479) 845-2109
Mailing address
PO BOX 6430, SPRINGDALE, AR 72766-6430
(479) 750-2020
(479) 845-2109
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
1761-C
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5X504
BLUE SHIELD PROVIDER #
AR
Enumeration date
06/13/2006
Last updated
07/08/2007
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