Provider Demographics
NPI:1265590590
Name:PITTENGER, SOL (PSYD)
Entity type:Individual
Prefix:
First Name:SOL
Middle Name:
Last Name:PITTENGER
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:888 PURCHASE ST UNIT 303
Mailing Address - Street 2:
Mailing Address - City:NEW BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02740-6217
Mailing Address - Country:US
Mailing Address - Phone:508-991-7010
Mailing Address - Fax:
Practice Address - Street 1:888 PURCHASE ST UNIT 303
Practice Address - Street 2:
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02740-6217
Practice Address - Country:US
Practice Address - Phone:508-991-7010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7733103TC0700X
RI00769103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0500721Medicaid
MAW40048Medicare ID - Type Unspecified