Provider Demographics
NPI:1679642268
Name:PITT, EMILY (LICSW)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:PITT
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6827 4TH ST NW APT 306
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20012-1984
Mailing Address - Country:US
Mailing Address - Phone:202-805-3927
Mailing Address - Fax:
Practice Address - Street 1:502 KENNEDY ST NW STE 2-A
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-3136
Practice Address - Country:US
Practice Address - Phone:202-656-6307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA111395101YM0800X, 1041C0700X
VA09040098791041C0700X
DCLC500792941041C0700X
MD176081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1303546Medicaid
MA1303546Medicaid
MA221867Medicare Oscar/Certification