Provider Demographics
NPI:1013213941
Name:WITTE, STEPHEN R (LCSW-R)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:R
Last Name:WITTE
Suffix:
Gender:M
Credentials:LCSW-R
Other - Prefix:
Other - First Name:STEPHEN
Other - Middle Name:R
Other - Last Name:WITTE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW
Mailing Address - Street 1:57 SOUTH ST APT 7
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-8173
Mailing Address - Country:US
Mailing Address - Phone:203-791-1234
Mailing Address - Fax:203-456-5117
Practice Address - Street 1:57 SOUTH ST APT 7
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810
Practice Address - Country:US
Practice Address - Phone:203-791-1234
Practice Address - Fax:203-456-5117
Is Sole Proprietor?:No
Enumeration Date:2011-02-10
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR020131-11041C0700X
CT6581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00274126Medicaid
NY00274126Medicaid