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General NPI Number Information
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NPI Number | 1093488587
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Entity Type | Individual
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Provider Name | SKYLAR MAYA WITTENBERG LCPC
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Gender | Female
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Dates
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Enumeration Date | 07/29/2021
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Last Update Date | 08/28/2025
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Provider Practice Location Address
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Address Line | 680 N LAKE SHORE DR STE 110-1113
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City | CHICAGO
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State | IL
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Zip | 60611-4546
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Country | US
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Telephone | 872-205-0456
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Fax |
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Provider Business Mailing Address
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Address Line | 426 W SURF ST APT 416
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City | CHICAGO
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State | IL
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Zip | 60657-6131
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Country | US
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Telephone | 216-832-7411
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State | IL
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