Provider Demographics
NPI:1477828572
Name:WITTENBERG, HEATHER LEE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:LEE
Last Name:WITTENBERG
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1787 WILI PA LOOP
Mailing Address - Street 2:SUITE 7
Mailing Address - City:WAILUKU
Mailing Address - State:HI
Mailing Address - Zip Code:96793-1280
Mailing Address - Country:US
Mailing Address - Phone:808-249-2121
Mailing Address - Fax:
Practice Address - Street 1:1787 WILI PA LOOP
Practice Address - Street 2:SUITE 7
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793-1280
Practice Address - Country:US
Practice Address - Phone:808-249-2121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-21
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI639103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist