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General NPI Number Information
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NPI Number | 1477678829
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Entity Type | Individual
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Provider Name | KATHLEEN CAMPBELL PITTAWAY MD
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Gender | Female
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Dates
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Enumeration Date | 03/21/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 66 DICKERSON RD UPPER VALLEY SERVICES
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City | MORETOWN
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State | VT
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Zip | 05660-9103
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Country | US
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Telephone | 802-496-7830
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Fax |
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Provider Business Mailing Address
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Address Line | 153 OLD WEST SHORE RD
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City | NORTH HERO
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State | VT
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Zip | 05474-9616
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Country | US
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Telephone | 802-388-4822
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Fax |
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 042-0008188
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License Number State | VT
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