MEDICARE: JORDAN WITT PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PSY15545	CA

General Provider Information

NPI Number	:	1063447118
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORDAN WITT PH.D.

Provider Business Mailing Address
First Line	:	1531 CHAPALA ST
Second Line	:	SUITE 2
City	:	SANTA BARBARA
State	:	CA
Zip	:	93101-3060
Country	:	US
Telephone Number	:	805-564-1763
Fax Number	:

Provider Business Practice Location Address
First Line	:	1531 CHAPALA ST
Second Line	:	SUITE 2
City	:	SANTA BARBARA
State	:	CA
Zip	:	93101-3060
Country	:	US
Telephone Number	:	805-564-1763
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/11/2006
Last Update Date	:	03/28/2014

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