Healthcare Provider Details

I. General information

NPI: 1679388706
Provider Name (Legal Business Name): NATALIE WITT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2025
Last Update Date: 02/07/2025
Certification Date: 02/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4115 BRIDGE AVE
CLEVELAND OH
44113-3304
US

IV. Provider business mailing address

2546 KENILWORTH RD APT 42
CLEVELAND HEIGHTS OH
44106-2491
US

V. Phone/Fax

Practice location:
  • Phone: 216-631-5800
  • Fax:
Mailing address:
  • Phone: 607-857-0469
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.2403845-TRNE
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: