Individual
CHRISTIAN WITHERELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PMHNP-BC
Contact information
Practice address
19995 SOUNDVIEW AVE, SOUTHOLD, NY 11971-2820
(631) 335-5541
(631) 939-2006
Mailing address
19995 SOUNDVIEW AVE, SOUTHOLD, NY 11971-2820
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
404304
NY
Other
Enumeration date
08/16/2022
Last updated
04/15/2025
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