Provider Demographics
NPI:1285131680
Name:PITTMAN, JACQUELINE ANNE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:ANNE
Last Name:PITTMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3715 MAHOGANY BEND DR
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34114-6424
Mailing Address - Country:US
Mailing Address - Phone:412-980-1431
Mailing Address - Fax:
Practice Address - Street 1:MONARCH WELLNESS, LLC
Practice Address - Street 2:12264 TAMIAMI TRAIL EAST, SUITE 202
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34113
Practice Address - Country:US
Practice Address - Phone:239-231-3208
Practice Address - Fax:239-228-5965
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-11
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW131971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty