Provider Demographics
NPI:1740289834
Name:ROBERTS-PITTMAN, BRIDGET J (HSPP)
Entity type:Individual
Prefix:DR
First Name:BRIDGET
Middle Name:J
Last Name:ROBERTS-PITTMAN
Suffix:
Gender:F
Credentials:HSPP
Other - Prefix:
Other - First Name:BRIDGET
Other - Middle Name:J
Other - Last Name:ROBERTS-PITTMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MFT
Mailing Address - Street 1:500 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47804-4072
Mailing Address - Country:US
Mailing Address - Phone:812-231-8376
Mailing Address - Fax:812-231-8208
Practice Address - Street 1:500 8TH AVE
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47804-4072
Practice Address - Country:US
Practice Address - Phone:812-231-8376
Practice Address - Fax:812-231-8208
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20042100A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN248800BMedicare ID - Type Unspecified