MEDICARE: STANLEY JAN WITNOV 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	103T00000X	Psychologist	PSY # 9369	CA

General Provider Information

NPI Number	:	1164578498
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STANLEY JAN WITNOV PH.D.

Provider Business Mailing Address
First Line	:	2312 EDGEWATER WAY
Second Line	:
City	:	SANTA BARBARA
State	:	CA
Zip	:	93109-1923
Country	:	US
Telephone Number	:	805-966-7729
Fax Number	:

Provider Business Practice Location Address
First Line	:	214 VIA SEVILLA
Second Line	:
City	:	SANTA BARBARA
State	:	CA
Zip	:	93109-1836
Country	:	US
Telephone Number	:	805-966-7729
Fax Number	:

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

Provider Enumeration Date	:	01/27/2007
Last Update Date	:	10/19/2012

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