Provider Demographics
NPI:1457895625
Name:THE GITTENS CLINIC INC
Entity Type:Organization
Organization Name:THE GITTENS CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:
Authorized Official - Last Name:GITTENS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:772-215-5905
Mailing Address - Street 1:789 SW FEDERAL HWY STE 212
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-2962
Mailing Address - Country:US
Mailing Address - Phone:772-288-4111
Mailing Address - Fax:772-905-3336
Practice Address - Street 1:789 SW FEDERAL HWY STE 212
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-2962
Practice Address - Country:US
Practice Address - Phone:772-288-4111
Practice Address - Fax:772-905-3336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-07
Last Update Date:2017-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder