Christian Witherell NP in Psychiatry PLLC
Organization Active NPI Psychiatric/Mental Health Nurse Practitioner · Southold, NY
NPI 1376314690 · NPPES record last updated Jan 15, 2024
Key facts
- NPI
- 1376314690
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner 363LP0808X
- Legal business name
- CHRISTIAN WITHERELL NP IN PSYCHIATRY PLLC
- Practice address
- 19995 Soundview Ave
Southold, NY 11971-2820 - Phone
- (631) 260-1326
- NPI assigned
- Jan 15, 2024
- Organization subpart
- No
Authorized official
- Name
- Christian Witherell, PMHNP-BC
- Title
- Sole Member
- Phone
- (631) 335-5541
Practitioners 2
-
Christian Witherell, PMHNP-BC
-
Maria V Purita, LCSW
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NY
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20240715002799 | NY | Part B Supplier - Clinic/Group Practice | 1951846971 |
Receives reassigned benefits from 1 practitioner Practice locations: Southold, NY |
National Provider Directory
Locations
56475 Main Rd
Bldg B
Southold, NY 11971
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric/Mental Health Nurse Practitioner |
363LP0808X | Yes |
Addresses
Primary practice location
19995 Soundview Ave
Southold, NY 11971-2820
Mailing address
19995 Soundview Ave
Southold, NY 11971-2820
Phone (631) 260-1326
Other providers in Southold, NY
- Anthony Cappadora
- Lynn A Cataldo
- Daniel R Charlebois
- Ellen Charnews
- Steven J.N. Chierchie
- Alfred Michael Ciletti
- Cara Clappi
- Vincent Michael Claps
- Saundra L Claud
- Helen M Cochran
All providers in Southold, NY · Psychiatric/Mental Health Nurse Practitioner in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 15, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.