Provider Demographics
NPI:1427388479
Name:WITTOCK-BROWN, ANN MAREE
Entity Type:Individual
Prefix:
First Name:ANN MAREE
Middle Name:
Last Name:WITTOCK-BROWN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 CASCADING CREEK LN
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-5917
Mailing Address - Country:US
Mailing Address - Phone:407-715-4705
Mailing Address - Fax:
Practice Address - Street 1:7410 S US HIGHWAY 1 STE 400
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-1420
Practice Address - Country:US
Practice Address - Phone:772-340-5750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-13
Last Update Date:2010-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional