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General NPI Number Information
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NPI Number | 1205179769
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Entity Type | Individual
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Provider Name | GLEN PITTMAN LMSW
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Gender | Male
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Dates
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Enumeration Date | 04/03/2013
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Last Update Date | 09/25/2025
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Provider Practice Location Address
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Address Line | 2300 PENNSYLVANIA AVE UNIT LLC
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City | WILMINGTON
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State | DE
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Zip | 19806-1392
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Country | US
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Telephone | 302-213-6158
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Fax | 855-530-2764
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Provider Business Mailing Address
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Address Line | 2300 PENNSYLVANIA AVE UNIT LLC
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City | WILMINGTON
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State | DE
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Zip | 19806-1392
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Country | US
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Telephone | 302-213-6158
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Fax | 855-530-2764
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | Q3-001083
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License Number State | DE
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