Healthcare Provider Details

I. General information

NPI: 1003597782
Provider Name (Legal Business Name): GEORGANN WITTE, PHD,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2023
Last Update Date: 07/26/2023
Certification Date: 07/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

295 WASHINGTON AVE STE 11
HAMDEN CT
06518-3025
US

IV. Provider business mailing address

295 WASHINGTON AVE STE 11
HAMDEN CT
06518-3025
US

V. Phone/Fax

Practice location:
  • Phone: 475-241-3767
  • Fax:
Mailing address:
  • Phone: 475-241-3767
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number
License Number State

VIII. Authorized Official

Name: GEORGANN WITTE
Title or Position: PSYCHOLOGIST/OWNER
Credential: PH.D.
Phone: 475-241-3767