Provider Demographics
NPI:1144209396
Name:DEWITT, MARTHA (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:
Last Name:DEWITT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 ALEXANDER AVE
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:MA
Mailing Address - Zip Code:02478-4802
Mailing Address - Country:US
Mailing Address - Phone:617-489-9302
Mailing Address - Fax:
Practice Address - Street 1:9 ALEXANDER AVE
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:MA
Practice Address - Zip Code:02478-4802
Practice Address - Country:US
Practice Address - Phone:617-489-9302
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-15
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6205103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW04957OtherBLUE CROSS BLUE SHIELD
MAW04957OtherBLUE CROSS BLUE SHIELD