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General NPI Number Information
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NPI Number | 1770989121
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Entity Type | Individual
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Provider Name | NICOLE PITSAVAS PSY.D.
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Gender | Female
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Dates
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Enumeration Date | 11/12/2014
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Last Update Date | 07/10/2025
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Provider Practice Location Address
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Address Line | 501 W REDLANDS BLVD STE B
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City | REDLANDS
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State | CA
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Zip | 92373-4642
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Country | US
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Telephone | 909-686-6233
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Fax | 909-353-4985
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Provider Business Mailing Address
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Address Line | 28410 BUFFALO MEADOWS RD
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City | REDLANDS
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State | CA
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Zip | 92373-7907
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Country | US
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Telephone | 773-294-2407
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PSY29303
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License Number State | CA
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