Provider Demographics
NPI:1922033398
Name:WITKIN, VALERIE (PHD)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:
Last Name:WITKIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 BLACK IRONWOOD RD APT 103
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-7853
Mailing Address - Country:US
Mailing Address - Phone:561-313-0730
Mailing Address - Fax:954-944-0308
Practice Address - Street 1:8259 N MILITARY TRL
Practice Address - Street 2:9
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33410-6352
Practice Address - Country:US
Practice Address - Phone:561-313-0730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2022-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY8791103TC0700X, 103T00000X
NY007681103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
00768168OtherHIP
FL010685700Medicaid
00768168OtherHIP
V21661Medicare ID - Type Unspecified
NY00815187Medicaid