Provider Demographics
NPI:1912949231
Name:WITECKI, MARGARET (PHD)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:
Last Name:WITECKI
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 1:99 E CENTRAL ST
Mailing Address - Street 2:
Mailing Address - City:NATICK
Mailing Address - State:MA
Mailing Address - Zip Code:01760-3647
Mailing Address - Country:US
Mailing Address - Phone:508-740-5033
Mailing Address - Fax:781-932-4140
Practice Address - Street 1:99 E CENTRAL ST
Practice Address - Street 2:
Practice Address - City:NATICK
Practice Address - State:MA
Practice Address - Zip Code:01760-3647
Practice Address - Country:US
Practice Address - Phone:508-740-5033
Practice Address - Fax:781-932-4140
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2315103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0510939Medicaid
MA170835OtherMAGELLAN
MAW02583OtherBLUE CROSS/BLUE SHIELD
MAW02583OtherBLUE CROSS/BLUE SHIELD
MAR44179Medicare UPIN