Provider Demographics
NPI:1649628637
Name:PITTS, PENELOPE (PHD)
Entity type:Individual
Prefix:
First Name:PENELOPE
Middle Name:
Last Name:PITTS
Suffix:
Gender:F
Credentials:PHD
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 441
Mailing Address - Street 2:
Mailing Address - City:FRANKFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19945-0441
Mailing Address - Country:US
Mailing Address - Phone:302-663-7790
Mailing Address - Fax:302-487-0577
Practice Address - Street 1:117 MAIN ST UNIT 1-2
Practice Address - Street 2:
Practice Address - City:MILLSBORO
Practice Address - State:DE
Practice Address - Zip Code:19966-8410
Practice Address - Country:US
Practice Address - Phone:302-663-7790
Practice Address - Fax:302-487-0577
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-31
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEPC-0000751101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty