Provider Demographics
NPI:1619290459
Name:PITTMAN, JILL (LMFT)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:PITTMAN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:
Other - Last Name:HEWITT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:600 E WEDDELL DR SPC 201
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94089-1742
Mailing Address - Country:US
Mailing Address - Phone:408-230-4804
Mailing Address - Fax:
Practice Address - Street 1:1885 THE ALAMEDA STE 204
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95126-1747
Practice Address - Country:US
Practice Address - Phone:408-230-4804
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-08
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF 57473106H00000X
CAMFC 52017106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist