Provider Demographics
NPI:1346031150
Name:PITSTICK, MARA (PPS)
Entity type:Individual
Prefix:
First Name:MARA
Middle Name:
Last Name:PITSTICK
Suffix:
Gender:F
Credentials:PPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5297 MAUREEN LN
Mailing Address - Street 2:
Mailing Address - City:MOORPARK
Mailing Address - State:CA
Mailing Address - Zip Code:93021-7125
Mailing Address - Country:US
Mailing Address - Phone:805-378-6301
Mailing Address - Fax:
Practice Address - Street 1:15300 MONROE AVE
Practice Address - Street 2:
Practice Address - City:MOORPARK
Practice Address - State:CA
Practice Address - Zip Code:93021-3220
Practice Address - Country:US
Practice Address - Phone:805-378-6301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-13
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty