Provider Demographics
NPI:1003597782
Name:GEORGANN WITTE, PHD,LLC
Entity Type:Organization
Organization Name:GEORGANN WITTE, PHD,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GEORGANN
Authorized Official - Middle Name:
Authorized Official - Last Name:WITTE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:475-241-3767
Mailing Address - Street 1:295 WASHINGTON AVE STE 11
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06518-3025
Mailing Address - Country:US
Mailing Address - Phone:475-241-3767
Mailing Address - Fax:
Practice Address - Street 1:295 WASHINGTON AVE STE 11
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06518-3025
Practice Address - Country:US
Practice Address - Phone:475-241-3767
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-26
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service