MEDICARE: REBECCA JUDITH WITTLIN M.S

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1619652351
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA JUDITH WITTLIN M.S

Provider Business Mailing Address
First Line	:	17 CONCORD DR
Second Line	:
City	:	PITTSFORD
State	:	NY
Zip	:	14534-4011
Country	:	US
Telephone Number	:	585-330-2089
Fax Number	:

Provider Business Practice Location Address
First Line	:	1545 EAST AVE
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14610-1676
Country	:	US
Telephone Number	:	585-524-0008
Fax Number	:

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

Provider Enumeration Date	:	06/20/2023
Last Update Date	:	06/20/2023

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