Provider Demographics
NPI:1437257060
Name:PITTMAN, SUSAN MARIE (LCSW)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:MARIE
Last Name:PITTMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5610 CRAWFORDSVILLE RD
Mailing Address - Street 2:STE 22
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46224-3727
Mailing Address - Country:US
Mailing Address - Phone:317-246-4027
Mailing Address - Fax:317-243-2328
Practice Address - Street 1:5610 CRAWFORDSVILLE RD
Practice Address - Street 2:STE 22
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46224-3727
Practice Address - Country:US
Practice Address - Phone:317-246-4027
Practice Address - Fax:317-243-2328
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
IN34007770A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100270530AMedicaid