Provider Demographics
NPI:1336446384
Name:PITMAN, SEAN (MSW, LCSW)
Entity type:Individual
Prefix:MR
First Name:SEAN
Middle Name:
Last Name:PITMAN
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5647 E MISSION BLVD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-9299
Mailing Address - Country:US
Mailing Address - Phone:479-856-3155
Mailing Address - Fax:479-521-1039
Practice Address - Street 1:5311 W VILLAGE PKWY
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-8102
Practice Address - Country:US
Practice Address - Phone:479-856-3155
Practice Address - Fax:479-521-1039
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-26
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1083-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1083-COtherLCSW