Derek J Wittman, LMHC-D (NY),LPC (PA)

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

008137 Issued in NY

Practice address

3737 Theodolite Dr
Baldwinsville, NY 13027-9346

Phone

(315) 281-9488

NPI assigned

May 2, 2013

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Apr 1, 2025 through Apr 1, 2027

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Sage in Time Mental Health Counseling, PLLC

  • Mental Health Counselor
  • Baldwinsville, NY
  • NPI 1245093780
  NPD Authorized official
• Conifer Park, Inc.

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Glenville, NY
  • NPI 1336339969
  NPD (past)
• Conifer Park, Inc.

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Liverpool, NY
  • NPI 1366498768
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1367452800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736726400000",
    "number": "1952746141",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3737 THEODOLITE DR",
            "city": "BALDWINSVILLE",
            "state": "NY",
            "postal_code": "130279346",
            "telephone_number": "315-743-8050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3737 THEODOLITE DR",
            "city": "BALDWINSVILLE",
            "state": "NY",
            "postal_code": "130279346",
            "telephone_number": "315-281-9488"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WITTMAN",
        "first_name": "DEREK",
        "middle_name": "J",
        "name_prefix": "Mr.",
        "credential": "LMHC-D (NY),LPC (PA)",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-05-02",
        "last_updated": "2025-01-13",
        "certification_date": "2025-01-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NY",
            "license": "008137",
            "primary": true
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "PA",
            "license": "PC013511",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Andrea Marie Willis, CCC/SLP
• Heather Anne Wilsey, CASAC
• Andrea Margaret Wilson
• Michele J Wilson, LPN
• Caitlin Christina Winders, OTR/L
• Agata Wojtasiewicz, MD.
• Dona Leigh Wonacott, PT
• Cynthia J. Wood, LCSW, MS, CASAC
• Patricia Woodruff, LMSW
• Kenneth Edward Wosneski, LMHC

• Mental Health Counselor in Baldwinsville, NY
• Providers in Baldwinsville, NY by specialty
• Mental Health Counselor in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.