Provider Demographics
NPI:1720197700
Name:PITTMAN, LAURIE (PHD)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:
Last Name:PITTMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:LAURIE
Other - Middle Name:
Other - Last Name:WALKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:3903 HARTZDALE DR
Mailing Address - Street 2:SUITE 305
Mailing Address - City:CAMP HILL
Mailing Address - State:PA
Mailing Address - Zip Code:17011-7836
Mailing Address - Country:US
Mailing Address - Phone:717-763-8650
Mailing Address - Fax:717-763-8653
Practice Address - Street 1:3903 HARTZDALE DR
Practice Address - Street 2:SUITE 305
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-7836
Practice Address - Country:US
Practice Address - Phone:717-763-8650
Practice Address - Fax:717-763-8653
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS007953L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist