Provider Demographics
NPI:1326464322
Name:PITARYS, NICHOLAS (LMSW)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:PITARYS
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 PISMIRE MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:RAYMOND
Mailing Address - State:ME
Mailing Address - Zip Code:04071-6176
Mailing Address - Country:US
Mailing Address - Phone:207-310-1001
Mailing Address - Fax:
Practice Address - Street 1:39 WESTERN AVE
Practice Address - Street 2:SUITE B
Practice Address - City:SOUTH PARIS
Practice Address - State:ME
Practice Address - Zip Code:04281-1412
Practice Address - Country:US
Practice Address - Phone:207-743-1677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-14
Last Update Date:2014-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECAC5531101YA0400X
MELM12288101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health