Provider Demographics
NPI:1366600611
Name:WITKIN, MICHELLE A (PHD)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:A
Last Name:WITKIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28494 WESTINGHOUSE PL
Mailing Address - Street 2:SUITE 203
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-0930
Mailing Address - Country:US
Mailing Address - Phone:661-753-3987
Mailing Address - Fax:
Practice Address - Street 1:28494 WESTINGHOUSE PL
Practice Address - Street 2:SUITE 203
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-0930
Practice Address - Country:US
Practice Address - Phone:661-753-3987
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-22
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY14855103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical