Provider Demographics
NPI:1033713227
Name:WHITAKER, BRIAN (CPS)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:WHITAKER
Suffix:
Gender:M
Credentials:CPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 E 14TH ST
Mailing Address - Street 2:
Mailing Address - City:HISTORIC NEW CASTLE
Mailing Address - State:DE
Mailing Address - Zip Code:19720-4510
Mailing Address - Country:US
Mailing Address - Phone:302-328-8633
Mailing Address - Fax:
Practice Address - Street 1:302 E 14TH ST
Practice Address - Street 2:
Practice Address - City:HISTORIC NEW CASTLE
Practice Address - State:DE
Practice Address - Zip Code:19720-4510
Practice Address - Country:US
Practice Address - Phone:302-328-8633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-28
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE1649175T00000X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No175T00000XOther Service ProvidersPeer SpecialistGroup - Single Specialty