Provider Demographics
NPI:1316929722
Name:DEWITT, JOHN P (PSYD HSPP)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:P
Last Name:DEWITT
Suffix:
Gender:M
Credentials:PSYD HSPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5233 TARRYTOWN RD
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:IN
Mailing Address - Zip Code:47630-2041
Mailing Address - Country:US
Mailing Address - Phone:812-428-6299
Mailing Address - Fax:
Practice Address - Street 1:4770 COVERT AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47714-5663
Practice Address - Country:US
Practice Address - Phone:812-428-6299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-19
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20040964A103TC0700X
KYKY-1066103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200014390Medicaid
IN000000039796OtherANTHEM INSURANCE CO