Provider Demographics
NPI:1013797281
Name:DEWITT, PAULA BLACK WORTSMAN (RBT)
Entity type:Individual
Prefix:MRS
First Name:PAULA
Middle Name:BLACK WORTSMAN
Last Name:DEWITT
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12930 VIA DEL VALEDOR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92129-3047
Mailing Address - Country:US
Mailing Address - Phone:415-525-6955
Mailing Address - Fax:
Practice Address - Street 1:9565 WAPLES ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-2986
Practice Address - Country:US
Practice Address - Phone:858-695-9444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-04
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARBT23288268106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician