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General NPI Number Information
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NPI Number | 1669942785
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Entity Type | Individual
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Provider Name | PAUL WITRI LLMSW
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Gender | Male
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Dates
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Enumeration Date | 12/01/2018
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Last Update Date | 12/05/2022
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Provider Practice Location Address
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Address Line | 1010 E WEST MAPLE RD
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City | WALLED LAKE
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State | MI
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Zip | 48390-3571
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Country | US
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Telephone | 248-313-2908
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Fax |
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Provider Business Mailing Address
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Address Line | 23237 PROVIDENCE DR APT 208
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City | SOUTHFIELD
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State | MI
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Zip | 48075-3618
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Country | US
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Telephone | 616-581-3719
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6801101607
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License Number State | MI
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