Healthcare Provider Details

I. General information

NPI: 1215996020
Provider Name (Legal Business Name): MARCY T. PITKIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2006
Last Update Date: 05/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 SE CENTRAL PKWY SUITE 100
STUART FL
34994-3904
US

IV. Provider business mailing address

1480 SE 13TH ST
STUART FL
34996-5812
US

V. Phone/Fax

Practice location:
  • Phone: 772-286-8093
  • Fax: 772-286-8093
Mailing address:
  • Phone: 772-286-8093
  • Fax: 772-286-8093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW2430
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: