Provider Demographics
NPI:1285057646
Name:WITZKY, MICHAEL E (PHD, LISW-S, LICDC-)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:E
Last Name:WITZKY
Suffix:
Gender:
Credentials:PHD, LISW-S, LICDC-
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1040 DELAWARE AVE
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:OH
Mailing Address - Zip Code:43302-6416
Mailing Address - Country:US
Mailing Address - Phone:740-383-7910
Mailing Address - Fax:
Practice Address - Street 1:990 S PROSPECT ST STE 3
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-6283
Practice Address - Country:US
Practice Address - Phone:740-383-7910
Practice Address - Fax:740-375-8129
Is Sole Proprietor?:No
Enumeration Date:2014-01-21
Last Update Date:2025-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.0004289-SUPV104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0172564Medicaid