Provider Demographics
NPI:1629438668
Name:WITT, GRAZYNA
Entity Type:Individual
Prefix:
First Name:GRAZYNA
Middle Name:
Last Name:WITT
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 1:36 IROQUIOS TRAIL
Mailing Address - Street 2:
Mailing Address - City:SMALLWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:12778
Mailing Address - Country:US
Mailing Address - Phone:845-701-6608
Mailing Address - Fax:
Practice Address - Street 1:17 HAMILTON AVE
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:NY
Practice Address - Zip Code:12701-1319
Practice Address - Country:US
Practice Address - Phone:845-794-8080
Practice Address - Fax:845-791-1716
Is Sole Proprietor?:No
Enumeration Date:2016-03-03
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)