Provider Demographics
NPI:1083587810
Name:PITTMAN, STEPHEN P (LICSW)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:P
Last Name:PITTMAN
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1350 ENERGY LN STE 101
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55108-5275
Mailing Address - Country:US
Mailing Address - Phone:651-313-5162
Mailing Address - Fax:
Practice Address - Street 1:1350 ENERGY LN STE 101
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55108-5275
Practice Address - Country:US
Practice Address - Phone:651-313-5162
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-26
Last Update Date:2025-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN351161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical