Provider Demographics
NPI:1891161568
Name:BITTMAN, JUSTINA MATHAI (LAC)
Entity Type:Individual
Prefix:MRS
First Name:JUSTINA
Middle Name:MATHAI
Last Name:BITTMAN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 PASADENA PL
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07506-2805
Mailing Address - Country:US
Mailing Address - Phone:201-937-8886
Mailing Address - Fax:
Practice Address - Street 1:545 ISLAND RD
Practice Address - Street 2:SUITE 2B
Practice Address - City:RAMSEY
Practice Address - State:NJ
Practice Address - Zip Code:07446-2813
Practice Address - Country:US
Practice Address - Phone:973-963-7367
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-18
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00270700101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health