Provider Demographics
NPI:1659496743
Name:PITTMAN, ALLEN W (BA, LSW)
Entity type:Individual
Prefix:
First Name:ALLEN
Middle Name:W
Last Name:PITTMAN
Suffix:
Gender:M
Credentials:BA, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:951 REXDALE DR
Mailing Address - Street 2:
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44221-4225
Mailing Address - Country:US
Mailing Address - Phone:330-940-2928
Mailing Address - Fax:
Practice Address - Street 1:3645 WARRENSVILLE CENTER RD
Practice Address - Street 2:SUITE 248
Practice Address - City:SHAKER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44122-5247
Practice Address - Country:US
Practice Address - Phone:216-295-7239
Practice Address - Fax:216-295-7240
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS0018052104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker