Basic Information
| Provider Information | |||||||||
| NPI: | 1033547690 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WITEK | ||||||||
| FirstName: | CAITLYN | ||||||||
| MiddleName: | MARIE | ||||||||
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| NameSuffix: | |||||||||
| Credential: | LMSW | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | CASE | ||||||||
| OtherFirstName: | CAITLYN | ||||||||
| OtherMiddleName: | MARIE | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | LMSW | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 13730 ELGIN ST | ||||||||
| Address2: | |||||||||
| City: | OAK PARK | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482371100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2489746565 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 22555 GREENFIELD RD STE 550 | ||||||||
| Address2: | |||||||||
| City: | SOUTHFIELD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480753703 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8445769226 | ||||||||
| FaxNumber: | 2488498313 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/17/2013 | ||||||||
| LastUpdateDate: | 04/19/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 6801096190 | MI | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.