Provider Demographics
NPI:1366793416
Name:PITTERS, BECKY (LMSW)
Entity type:Individual
Prefix:MS
First Name:BECKY
Middle Name:
Last Name:PITTERS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1329 KINGSLEY ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT CLEMENS
Mailing Address - State:MI
Mailing Address - Zip Code:48043-3052
Mailing Address - Country:US
Mailing Address - Phone:586-420-0817
Mailing Address - Fax:
Practice Address - Street 1:1329 KINGSLEY ST
Practice Address - Street 2:
Practice Address - City:MOUNT CLEMENS
Practice Address - State:MI
Practice Address - Zip Code:48043-3052
Practice Address - Country:US
Practice Address - Phone:586-420-0817
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-28
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010914101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical