Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | PS-008220-L | PA |
NPI | 1114067949 |
---|---|
Provider Name | Wendy Whitman |
First Address | Philadelphia, PA 19111-1325 |
Second Address | Philadelphia, PA 19111-1325 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/02/2007 |
Last Update Date | 08/07/2007 |