Provider Demographics
NPI:1770621237
Name:HITTMAN, SHEILA REAGER (LCSW)
Entity type:Individual
Prefix:MRS
First Name:SHEILA
Middle Name:REAGER
Last Name:HITTMAN
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 1:111 BERKELEY PL
Mailing Address - Street 2:
Mailing Address - City:GLEN ROCK
Mailing Address - State:NJ
Mailing Address - Zip Code:07452-2331
Mailing Address - Country:US
Mailing Address - Phone:201-447-4413
Mailing Address - Fax:201-447-0545
Practice Address - Street 1:61 N MAPLE AVE
Practice Address - Street 2:SUITE 306
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-3255
Practice Address - Country:US
Practice Address - Phone:201-444-0071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJSCO44201041C0700X
NY282421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
R81345Medicare UPIN
638802Medicare ID - Type Unspecified