Provider Demographics
NPI:1760068100
Name:GITTENS, NADIA ANGELLE (LSW)
Entity Type:Individual
Prefix:MRS
First Name:NADIA
Middle Name:ANGELLE
Last Name:GITTENS
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7687 BARROW DR
Mailing Address - Street 2:
Mailing Address - City:MACUNGIE
Mailing Address - State:PA
Mailing Address - Zip Code:18062-2082
Mailing Address - Country:US
Mailing Address - Phone:134-737-2138
Mailing Address - Fax:
Practice Address - Street 1:5300 KIDSPEACE DR
Practice Address - Street 2:
Practice Address - City:OREFIELD
Practice Address - State:PA
Practice Address - Zip Code:18069-2000
Practice Address - Country:US
Practice Address - Phone:347-372-1387
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-23
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW136894101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)