Provider Demographics
NPI:1467020305
Name:PITTMAN, MACEE ELIZABETH
Entity Type:Individual
Prefix:
First Name:MACEE
Middle Name:ELIZABETH
Last Name:PITTMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1831 GOLDEN EAGLE WAY STE 34
Mailing Address - Street 2:
Mailing Address - City:FLEMING ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32003-4340
Mailing Address - Country:US
Mailing Address - Phone:904-579-4770
Mailing Address - Fax:
Practice Address - Street 1:1319 CALLE AVANZADO
Practice Address - Street 2:
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92673-6351
Practice Address - Country:US
Practice Address - Phone:949-272-6146
Practice Address - Fax:888-847-8864
Is Sole Proprietor?:No
Enumeration Date:2021-06-16
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician