Provider Demographics
NPI:1639691165
Name:SITTA, JOANNA MARIE
Entity Type:Individual
Prefix:MRS
First Name:JOANNA
Middle Name:MARIE
Last Name:SITTA
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:JOANNA
Other - Middle Name:MARIE
Other - Last Name:GALIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5302 S FLORIDA AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813-4910
Mailing Address - Country:US
Mailing Address - Phone:863-937-8067
Mailing Address - Fax:
Practice Address - Street 1:5302 S FLORIDA AVE STE 202
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-4910
Practice Address - Country:US
Practice Address - Phone:863-937-8067
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-17
Last Update Date:2017-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0-16-7440103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst