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General NPI Number Information
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NPI Number | 1053732883
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Entity Type | Organization
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Legal Business Name | PITTMAN BEHAVIORAL HEALTH LLC
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Dates
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Enumeration Date | 12/20/2013
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Last Update Date | 12/20/2013
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Provider Practice Location Address
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Address Line | 102 SLEEPY HOLLOW DR SUITE 204 BUNKER HILL BUILDING
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City | MIDDLETOWN
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State | DE
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Zip | 19709-5841
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Country | US
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Telephone | 302-365-0384
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Fax |
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Provider Business Mailing Address
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Address Line | 8 BORDEAUX BLVD
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City | NEWARK
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State | DE
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Zip | 19702-4546
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Country | US
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Telephone | 302-521-9954
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Fax |
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Authorized Official
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Title or Position | OWNER/NURSE PRACTITIONER
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Name | TARESA PITTMAN
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Credential | NP
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Telephone | 302-365-0384
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | L8-0000124
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License Number State | DE
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