Provider Demographics
NPI:1447089370
Name:PITCHER, JAIME LYNNE (MA, LAC)
Entity type:Individual
Prefix:
First Name:JAIME
Middle Name:LYNNE
Last Name:PITCHER
Suffix:
Gender:F
Credentials:MA, LAC
Other - Prefix:
Other - First Name:JAIME
Other - Middle Name:LYNNE
Other - Last Name:FUDALIK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LAC
Mailing Address - Street 1:420 VIRGINIA DR
Mailing Address - Street 2:
Mailing Address - City:BROWNS MILLS
Mailing Address - State:NJ
Mailing Address - Zip Code:08015-5431
Mailing Address - Country:US
Mailing Address - Phone:609-709-9116
Mailing Address - Fax:
Practice Address - Street 1:112 S NEW YORK RD # 8205
Practice Address - Street 2:
Practice Address - City:GALLOWAY
Practice Address - State:NJ
Practice Address - Zip Code:08205-9608
Practice Address - Country:US
Practice Address - Phone:609-428-4300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-30
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00474300101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor