Provider Demographics
NPI:1457860256
Name:WITTE, RAYMOND (PHD)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:
Last Name:WITTE
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:PO BOX 35216
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44735-5216
Mailing Address - Country:US
Mailing Address - Phone:330-966-0922
Mailing Address - Fax:877-850-4646
Practice Address - Street 1:514 HIGH ST
Practice Address - Street 2:
Practice Address - City:WAYNESVILLE
Practice Address - State:OH
Practice Address - Zip Code:45068-9784
Practice Address - Country:US
Practice Address - Phone:330-966-0922
Practice Address - Fax:877-850-4646
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-25
Last Update Date:2017-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH463103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical