Provider Demographics
NPI:1841078037
Name:WITTENBERG, MADELEINE FLORA (PHD)
Entity type:Individual
Prefix:
First Name:MADELEINE
Middle Name:FLORA
Last Name:WITTENBERG
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:MADELEINE
Other - Middle Name:FLORA
Other - Last Name:COHEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:2 BROOKLINE PL
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02445-7230
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2 BROOKLINE PL
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02445-7230
Practice Address - Country:US
Practice Address - Phone:617-355-6680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-19
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPSY10000470103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent