Provider Demographics
NPI:1043543663
Name:PITZER, DANIEL PAUL (LCSW)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:PAUL
Last Name:PITZER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:651 MONMOUTH AVE
Mailing Address - Street 2:
Mailing Address - City:PORT MONMOUTH
Mailing Address - State:NJ
Mailing Address - Zip Code:07758-1517
Mailing Address - Country:US
Mailing Address - Phone:732-298-0301
Mailing Address - Fax:
Practice Address - Street 1:248 MAIN ST
Practice Address - Street 2:
Practice Address - City:CHATHAM
Practice Address - State:NJ
Practice Address - Zip Code:07928-2412
Practice Address - Country:US
Practice Address - Phone:732-298-0301
Practice Address - Fax:732-495-1606
Is Sole Proprietor?:No
Enumeration Date:2009-09-14
Last Update Date:2019-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0556641041C0700X
NJ44SC051856001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ179291OtherMEDICARE PTAN