Provider Demographics
NPI:1619652351
Name:WITTLIN, REBECCA JUDITH (MS)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:JUDITH
Last Name:WITTLIN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 CONCORD DR
Mailing Address - Street 2:
Mailing Address - City:PITTSFORD
Mailing Address - State:NY
Mailing Address - Zip Code:14534-4011
Mailing Address - Country:US
Mailing Address - Phone:585-330-2089
Mailing Address - Fax:
Practice Address - Street 1:1545 EAST AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14610-1676
Practice Address - Country:US
Practice Address - Phone:585-524-0008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-20
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health