Provider Demographics
NPI:1033690268
Name:WITTLIN, ELLEN BETH
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:BETH
Last Name:WITTLIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ELLEN
Other - Middle Name:
Other - Last Name:OSTROVSKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:247 STATION DR STE NW1
Mailing Address - Street 2:
Mailing Address - City:WESTWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02090-2399
Mailing Address - Country:US
Mailing Address - Phone:617-754-1104
Mailing Address - Fax:617-754-1040
Practice Address - Street 1:247 STATION DR STE NW1
Practice Address - Street 2:
Practice Address - City:WESTWOOD
Practice Address - State:MA
Practice Address - Zip Code:02090-2399
Practice Address - Country:US
Practice Address - Phone:617-754-1104
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-26
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1199711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical