Provider Demographics
NPI:1215996020
Name:PITKIN, MARCY T
Entity type:Individual
Prefix:
First Name:MARCY
Middle Name:T
Last Name:PITKIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1480 SE 13TH ST
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34996-5812
Mailing Address - Country:US
Mailing Address - Phone:772-286-8093
Mailing Address - Fax:772-286-8093
Practice Address - Street 1:909 SE CENTRAL PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-3904
Practice Address - Country:US
Practice Address - Phone:772-286-8093
Practice Address - Fax:772-286-8093
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-21
Last Update Date:2010-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW24301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
1215996020OtherNIPPES