MEDICARE: DR. MICHELLE A WITKIN PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PSY14855	CA

General Provider Information

NPI Number	:	1366600611
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHELLE A WITKIN PH.D.

Provider Business Mailing Address
First Line	:	28494 WESTINGHOUSE PL
Second Line	:	SUITE 203
City	:	VALENCIA
State	:	CA
Zip	:	91355-0930
Country	:	US
Telephone Number	:	661-753-3987
Fax Number	:

Provider Business Practice Location Address
First Line	:	28494 WESTINGHOUSE PL
Second Line	:	SUITE 203
City	:	VALENCIA
State	:	CA
Zip	:	91355-0930
Country	:	US
Telephone Number	:	661-753-3987
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/22/2008
Last Update Date	:	01/09/2017

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