Provider Demographics
NPI:1255383618
Name:WITTERSGREEN, RUTH (PHD)
Entity type:Individual
Prefix:DR
First Name:RUTH
Middle Name:
Last Name:WITTERSGREEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:RUTH
Other - Middle Name:
Other - Last Name:WITTERS-GREEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:1666 32ND ST NW
Mailing Address - Street 2:#1
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20007
Mailing Address - Country:US
Mailing Address - Phone:202-407-3042
Mailing Address - Fax:
Practice Address - Street 1:1666 32ND STREET, NW
Practice Address - Street 2:#1
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20007
Practice Address - Country:US
Practice Address - Phone:202-407-3042
Practice Address - Fax:202-333-2525
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810003439103TC0700X
DCPSY1000580103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010103860Medicaid
374723OtherANTHEM BLUE SHIELD
VA006324A76Medicare ID - Type UnspecifiedMEDICARE