Provider Demographics
NPI:1730734575
Name:WITTMAN, MARY ROSE
Entity type:Individual
Prefix:MRS
First Name:MARY ROSE
Middle Name:
Last Name:WITTMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4922 OREGON RD
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14075-2619
Mailing Address - Country:US
Mailing Address - Phone:716-225-4263
Mailing Address - Fax:
Practice Address - Street 1:100 HINDS ST
Practice Address - Street 2:
Practice Address - City:TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14150-1815
Practice Address - Country:US
Practice Address - Phone:716-694-7690
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-08
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool