Provider Demographics
NPI:1144234410
Name:BITTMAN, MARILYN (MED)
Entity Type:Individual
Prefix:MS
First Name:MARILYN
Middle Name:
Last Name:BITTMAN
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 545
Mailing Address - Street 2:
Mailing Address - City:CHESHIRE
Mailing Address - State:MA
Mailing Address - Zip Code:01225-0545
Mailing Address - Country:US
Mailing Address - Phone:413-743-1520
Mailing Address - Fax:413-637-4735
Practice Address - Street 1:45 WALKER ST
Practice Address - Street 2:
Practice Address - City:LENOX
Practice Address - State:MA
Practice Address - Zip Code:01240-2717
Practice Address - Country:US
Practice Address - Phone:413-743-1520
Practice Address - Fax:413-637-4735
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA98101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health