Provider Demographics
NPI:1942808886
Name:WITT, JOAN MARIE (LCSW)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:MARIE
Last Name:WITT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JOAN
Other - Middle Name:MARIE
Other - Last Name:RANGEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSW
Mailing Address - Street 1:205 E HICKORY LN
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46227-2447
Mailing Address - Country:US
Mailing Address - Phone:317-658-5563
Mailing Address - Fax:
Practice Address - Street 1:205 E HICKORY LN
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-2447
Practice Address - Country:US
Practice Address - Phone:317-658-5563
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-13
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34007652A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical