Provider Demographics
NPI:1861173064
Name:PITBULL PSYCH, LLC
Entity type:Organization
Organization Name:PITBULL PSYCH, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PSYCHIACTRIC NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:HARRIET
Authorized Official - Middle Name:
Authorized Official - Last Name:BOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, PMHNP-BC
Authorized Official - Phone:973-343-1999
Mailing Address - Street 1:455 KILBURY RD
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:OH
Mailing Address - Zip Code:43302-4530
Mailing Address - Country:US
Mailing Address - Phone:973-343-1999
Mailing Address - Fax:
Practice Address - Street 1:455 KILBURY RD
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-4530
Practice Address - Country:US
Practice Address - Phone:973-343-1999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-31
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty