Provider Demographics
NPI:1093488587
Name:WITTENBERG, SKYLAR MAYA (LCPC)
Entity type:Individual
Prefix:
First Name:SKYLAR
Middle Name:MAYA
Last Name:WITTENBERG
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:426 W SURF ST APT 416
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-6131
Mailing Address - Country:US
Mailing Address - Phone:216-832-7411
Mailing Address - Fax:
Practice Address - Street 1:680 N LAKE SHORE DR STE 110-1113
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-4546
Practice Address - Country:US
Practice Address - Phone:872-205-0456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-29
Last Update Date:2025-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health