Healthcare Provider Details

I. General information

NPI: 1932293842
Provider Name (Legal Business Name): DELWIN L PITZER PSWD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 10/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 FOUNTAINEBLEAU CIR
DAYTONA BEACH FL
32118-4008
US

IV. Provider business mailing address

PO BOX 934068
MARGATE FL
33093-4068
US

V. Phone/Fax

Practice location:
  • Phone: 386-257-3892
  • Fax: 954-366-2056
Mailing address:
  • Phone: 954-366-2700
  • Fax: 954-366-2056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY5371
License Number StateFL

VIII. Authorized Official

Name: DR. DELWIN L PITZER
Title or Position: PRESIDENT
Credential: PSY.D PA
Phone: 386-257-3892