MEDICARE: DR. MOLLY ROMER WITTEN PH.D.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number State
1	103TC0700X	Clinical Psychologist	IL
2	103TC2200X	Clinical Child & Adolescent Psychologist	IL
3	103TM1800X	Intellectual & Developmental Disabilities Psychologist	IL
4	103TP0814X	Psychoanalysis Psychologist	IL

General Provider Information

NPI Number	:	1992728638
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MOLLY ROMER WITTEN PH.D.

Provider Business Mailing Address
First Line	:	122 S MICHIGAN AVE
Second Line	:	SUITE 1301
City	:	CHICAGO
State	:	IL
Zip	:	60603-6191
Country	:	US
Telephone Number	:	312-765-0246
Fax Number	:	773-493-9104

Provider Business Practice Location Address
First Line	:	122 S MICHIGAN AVE
Second Line	:	SUITE 1301
City	:	CHICAGO
State	:	IL
Zip	:	60603-6191
Country	:	US
Telephone Number	:	312-765-0246
Fax Number	:	773-493-9104

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

Provider Enumeration Date	:	07/25/2006
Last Update Date	:	08/09/2007

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