Provider Demographics
NPI:1073887816
Name:PAUL B. WHITTEMORE, PH.D., A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:PAUL B. WHITTEMORE, PH.D., A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:B
Authorized Official - Last Name:WHITTEMORE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:949-752-7753
Mailing Address - Street 1:1001 DOVE ST
Mailing Address - Street 2:SUITE 145
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-2838
Mailing Address - Country:US
Mailing Address - Phone:949-752-7753
Mailing Address - Fax:949-752-6463
Practice Address - Street 1:1001 DOVE ST
Practice Address - Street 2:SUITE 145
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2838
Practice Address - Country:US
Practice Address - Phone:949-752-7753
Practice Address - Fax:949-752-6463
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-24
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY-11060103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty