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General NPI Number Information
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NPI Number | 1205492840
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Entity Type | Individual
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Provider Name | MOLLY WITKUS
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Gender | Female
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Dates
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Enumeration Date | 05/17/2019
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Last Update Date | 05/17/2019
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Provider Practice Location Address
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Address Line | 476 APPLETON ST
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City | HOLYOKE
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State | MA
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Zip | 01040-4186
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Country | US
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Telephone | 617-320-4538
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Fax |
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Provider Business Mailing Address
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Address Line | 103 STEIGER DR
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City | WESTFIELD
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State | MA
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Zip | 01085-4931
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Country | US
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Telephone | 617-320-4538
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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 | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number |
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License Number State |
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