Basic Information
| Provider Information | |||||||||
| NPI: | 1609406131 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DEWITT | ||||||||
| FirstName: | ANDREA | ||||||||
| MiddleName: | RENEE | ||||||||
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| Credential: | MA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3700 IDLEBROOK CIR APT 106 | ||||||||
| Address2: | |||||||||
| City: | CASSELBERRY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327075505 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4079199424 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2479 ALOMA AVE | ||||||||
| Address2: | |||||||||
| City: | WINTER PARK | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327922541 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4076576692 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/23/2020 | ||||||||
| LastUpdateDate: | 01/23/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 01/23/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.