Provider Demographics
NPI:1376633180
Name:WITTER, JEANETTE MARIE (PHD)
Entity Type:Individual
Prefix:DR
First Name:JEANETTE
Middle Name:MARIE
Last Name:WITTER
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 1:7981 EASTERN AVE
Mailing Address - Street 2:SUITE C-5
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-4834
Mailing Address - Country:US
Mailing Address - Phone:301-587-1919
Mailing Address - Fax:301-587-2943
Practice Address - Street 1:7981 EASTERN AVE
Practice Address - Street 2:SUITE C-5
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-4834
Practice Address - Country:US
Practice Address - Phone:301-587-1919
Practice Address - Fax:301-587-2943
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2010-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD02263103TC0700X
DCPSY1728103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
310178200OtherACS OWCP PROVIDER NUMBER
310178200OtherACS OWCP PROVIDER NUMBER