Individual
DR. MITCHELL THOMAS WITTENBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PH.D., LP
Contact information
Practice address
JEWISH FAMILY SERVICE OF ST. PAUL, 1633 WEST SEVENTH STREET, ST. PAUL, MN 55102
(651) 698-0767
(651) 698-0162
Mailing address
687 DECORAH LN, MENDOTA HEIGHTS, MN 55120-1672
(651) 454-0398
(651) 698-0162
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
LP3061
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
104535
UCARE OF MN
MN
01
—
112501
HEALTHEAST CARE SYSTEM
MN
01
—
20124
BEHAVIORAL HEALTHCARE PRO
MN
01
—
61-13693
UNITED BEHAVIORAL HEALTH
MN
01
—
7H396WI
BLUE CROSS BLUE SHIELD
MN
Enumeration date
11/30/2006
Last updated
07/09/2007
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