Provider Demographics
NPI:1407922933
Name:PITT, NORMAN WALTER (PHD)
Entity type:Individual
Prefix:DR
First Name:NORMAN
Middle Name:WALTER
Last Name:PITT
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1239 SHACKAMAXON STREET
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19125-3913
Mailing Address - Country:US
Mailing Address - Phone:215-247-6464
Mailing Address - Fax:610-519-7909
Practice Address - Street 1:7932 GERMANTOWN AVE
Practice Address - Street 2:(REAR OFFICE SUITE)
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19118-3511
Practice Address - Country:US
Practice Address - Phone:215-247-6464
Practice Address - Fax:610-519-4050
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-27
Last Update Date:2017-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS-003177-L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA425153Medicare ID - Type UnspecifiedLICENSED PSYCHOLOGIST