Provider Demographics
NPI:1043754948
Name:WITT, KIMBERLY (LCSW)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:WITT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1018 N CHRISTIAN ST STE 203
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17602-1900
Mailing Address - Country:US
Mailing Address - Phone:717-820-7748
Mailing Address - Fax:
Practice Address - Street 1:1018 N CHRISTIAN ST STE 203
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17602-1900
Practice Address - Country:US
Practice Address - Phone:717-820-7748
Practice Address - Fax:570-253-5990
Is Sole Proprietor?:No
Enumeration Date:2016-12-12
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW133938104100000X
PACW0212111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1036677420001Medicaid