Provider Demographics
NPI:1467453795
Name:ZITOWITZ, PAUL (ACSW LCSW)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:ZITOWITZ
Suffix:
Gender:M
Credentials:ACSW LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2691 PANORAMA DR
Mailing Address - Street 2:
Mailing Address - City:SAUTEE NACOOCHEE
Mailing Address - State:GA
Mailing Address - Zip Code:30571-3915
Mailing Address - Country:US
Mailing Address - Phone:706-969-1017
Mailing Address - Fax:
Practice Address - Street 1:2691 PANORAMA DR
Practice Address - Street 2:
Practice Address - City:SAUTEE NACOOCHEE
Practice Address - State:GA
Practice Address - Zip Code:30571-3915
Practice Address - Country:US
Practice Address - Phone:706-969-1017
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 5227104100000X
GACSW0036381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA044250222BMedicaid
GA044250222BMedicaid
GA80BBGJSMedicare PIN