Provider Demographics
NPI:1982185690
Name:PITRE, GEORGE DAVID (MA,BSL)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:DAVID
Last Name:PITRE
Suffix:
Gender:M
Credentials:MA,BSL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 ALLEGANY AVE
Mailing Address - Street 2:
Mailing Address - City:COUDERSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:16915-1504
Mailing Address - Country:US
Mailing Address - Phone:814-598-3429
Mailing Address - Fax:814-598-3429
Practice Address - Street 1:62 PLAZA LN
Practice Address - Street 2:
Practice Address - City:WELLSBORO
Practice Address - State:PA
Practice Address - Zip Code:16901-1766
Practice Address - Country:US
Practice Address - Phone:570-724-7142
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-22
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH003838101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional