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NPI Code Detail

MEDICARE: MS. MARY PITTMAN LCSW

MEDICARE: MS. MARY PITTMAN LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social WorkerIL

General Provider Information

NPI Number : 1184746943
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. MARY PITTMAN LCSW
Provider Business Mailing Address
First Line : 922 NORTH BLVD
Second Line : 206
City : OAK PARK
State : IL
Zip : 60301-1252
Country : US
Telephone Number : 708-763-8439
Fax Number :
Provider Business Practice Location Address
First Line : 10537 S ROBERTS RD
Second Line :
City : PALOS HILLS
State : IL
Zip : 60465-1933
Country : US
Telephone Number : 708-974-5117
Fax Number : 708-974-2498
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/04/2007
Last Update Date : 07/08/2007

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Directions to “ MS. MARY PITTMAN LCSW” Practice Location

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