Provider Demographics
NPI:1164578498
Name:WITNOV, STANLEY JAN (PHD)
Entity Type:Individual
Prefix:
First Name:STANLEY
Middle Name:JAN
Last Name:WITNOV
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2312 EDGEWATER WAY
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93109-1923
Mailing Address - Country:US
Mailing Address - Phone:805-966-7729
Mailing Address - Fax:
Practice Address - Street 1:214 VIA SEVILLA
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93109-1836
Practice Address - Country:US
Practice Address - Phone:805-966-7729
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-27
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY # 9369103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist