Provider Demographics
NPI:1508030867
Name:KATHERINE A WITT PSYD LLC
Entity Type:Organization
Organization Name:KATHERINE A WITT PSYD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:A
Authorized Official - Last Name:WITT
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:808-497-6456
Mailing Address - Street 1:527 AUWAI ST
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-2431
Mailing Address - Country:US
Mailing Address - Phone:808-497-6456
Mailing Address - Fax:
Practice Address - Street 1:527 AUWAI ST
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-2431
Practice Address - Country:US
Practice Address - Phone:808-497-6456
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-17
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI921103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty