Provider Demographics
NPI:1932293842
Name:DELWIN L PITZER PSWD PA
Entity Type:Organization
Organization Name:DELWIN L PITZER PSWD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DELWIN
Authorized Official - Middle Name:L
Authorized Official - Last Name:PITZER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD PA
Authorized Official - Phone:386-257-3892
Mailing Address - Street 1:PO BOX 934068
Mailing Address - Street 2:
Mailing Address - City:MARGATE
Mailing Address - State:FL
Mailing Address - Zip Code:33093-4068
Mailing Address - Country:US
Mailing Address - Phone:954-366-2700
Mailing Address - Fax:954-366-2056
Practice Address - Street 1:6 FOUNTAINEBLEAU CIR
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32118-4008
Practice Address - Country:US
Practice Address - Phone:386-257-3892
Practice Address - Fax:954-366-2056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2010-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY5371103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK5209Medicare ID - Type Unspecified