Healthcare Provider Details

I. General information

NPI: 1770552044
Provider Name (Legal Business Name): SONYA GITTELMAN L.C.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 RIVES RD SUITE B
PETERSBURG VA
23805-9255
US

IV. Provider business mailing address

PO BOX 1997
PETERSBURG VA
23805-0997
US

V. Phone/Fax

Practice location:
  • Phone: 804-732-1527
  • Fax: 804-732-8210
Mailing address:
  • Phone: 804-732-1527
  • Fax: 804-732-8210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904002666
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: