Provider Demographics
NPI:1407926652
Name:PITTELLA, LINDA JOAN (LICSW)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:JOAN
Last Name:PITTELLA
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 PINEHURST DR
Mailing Address - Street 2:
Mailing Address - City:WAREHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02571-2072
Mailing Address - Country:US
Mailing Address - Phone:508-295-2311
Mailing Address - Fax:
Practice Address - Street 1:400 NATHAN ELLIS HWY
Practice Address - Street 2:SUITE 1
Practice Address - City:MASHPEE
Practice Address - State:MA
Practice Address - Zip Code:02649-3143
Practice Address - Country:US
Practice Address - Phone:508-477-5488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1064301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical