Provider Demographics
NPI:1700255163
Name:PURINTON, MATTHEW CHARLES PITTMAN (LCSW)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:CHARLES PITTMAN
Last Name:PURINTON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4025 CHESTNUT STREET
Mailing Address - Street 2:FIRST FLOOR, COUNCIL FOR RELATIONSHIPS
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104
Mailing Address - Country:US
Mailing Address - Phone:215-382-6680
Mailing Address - Fax:215-386-1743
Practice Address - Street 1:4025 CHESTNUT STREET
Practice Address - Street 2:FIRST FLOOR, COUNCIL FOR RELATIONSHIPS
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104
Practice Address - Country:US
Practice Address - Phone:215-382-6680
Practice Address - Fax:215-386-1743
Is Sole Proprietor?:No
Enumeration Date:2015-09-16
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW018087101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health