Provider Demographics
NPI:1528492519
Name:PITTENGER, REBECCA ANN (PHD)
Entity type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:ANN
Last Name:PITTENGER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 W DANA ST STE 204
Mailing Address - Street 2:
Mailing Address - City:NIPOMO
Mailing Address - State:CA
Mailing Address - Zip Code:93444-9131
Mailing Address - Country:US
Mailing Address - Phone:323-739-8444
Mailing Address - Fax:
Practice Address - Street 1:151 W DANA ST STE 204
Practice Address - Street 2:
Practice Address - City:NIPOMO
Practice Address - State:CA
Practice Address - Zip Code:93444-9131
Practice Address - Country:US
Practice Address - Phone:323-739-8444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-26
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 25875103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical