Provider Demographics
NPI:1154330132
Name:WITTE, GEORGANN (PHD)
Entity type:Individual
Prefix:DR
First Name:GEORGANN
Middle Name:
Last Name:WITTE
Suffix:
Gender:
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:295 WASHINGTON AVE
Mailing Address - Street 2:SUITE 11
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06518-3025
Mailing Address - Country:US
Mailing Address - Phone:475-241-3767
Mailing Address - Fax:203-281-0235
Practice Address - Street 1:295 WASHINGTON AVE
Practice Address - Street 2:SUITE 11
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06518-3025
Practice Address - Country:US
Practice Address - Phone:475-241-3767
Practice Address - Fax:203-281-0235
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001730103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
C02578OtherGROUP#