Provider Demographics
NPI:1942451505
Name:WITWER, JEFFREY J (MSW, LSW)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:J
Last Name:WITWER
Suffix:
Gender:M
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 S EDWIN C MOSES BLVD
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45417-3424
Mailing Address - Country:US
Mailing Address - Phone:937-734-8333
Mailing Address - Fax:937-865-9069
Practice Address - Street 1:1170 E CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:WEST CARROLLTON
Practice Address - State:OH
Practice Address - Zip Code:45449-1825
Practice Address - Country:US
Practice Address - Phone:937-865-9061
Practice Address - Fax:937-865-9069
Is Sole Proprietor?:No
Enumeration Date:2008-10-01
Last Update Date:2018-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS00028121101YP2500X
OHI.18013101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional