Individual
MARYELLEN FITZGERALD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LADC
Contact information
Practice address
135 GRANGER ST, RUTLAND, VT 05701-4405
(802) 775-8224
(802) 747-7699
Mailing address
135 GRANGER ST, RUTLAND, VT 05701-4405
(802) 775-8224
(802) 747-7699
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
000592
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000592
LADC LICENSE
VT
Enumeration date
07/10/2013
Last updated
07/10/2013
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