Provider Demographics
NPI:1770552044
Name:GITTELMAN, SONYA (LCSW)
Entity type:Individual
Prefix:MS
First Name:SONYA
Middle Name:
Last Name:GITTELMAN
Suffix:
Gender:F
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:PO BOX 1997
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23805-0997
Mailing Address - Country:US
Mailing Address - Phone:804-732-1527
Mailing Address - Fax:804-732-8210
Practice Address - Street 1:43 RIVES RD
Practice Address - Street 2:SUITE B
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23805-9255
Practice Address - Country:US
Practice Address - Phone:804-732-1527
Practice Address - Fax:804-732-8210
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040026661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
C08729OtherMEDICARE GROUP NUMBER
C08729OtherMEDICARE GROUP NUMBER
002862C29Medicare ID - Type Unspecified