Provider Demographics
NPI:1093931230
Name:WHITE, CLEONIE V (PH D)
Entity Type:Individual
Prefix:DR
First Name:CLEONIE
Middle Name:V
Last Name:WHITE
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:DR
Other - First Name:CLEONIE
Other - Middle Name:
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PH D
Mailing Address - Street 1:1501 LEXINGTON AVENUE
Mailing Address - Street 2:#8B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029
Mailing Address - Country:US
Mailing Address - Phone:212-360-6570
Mailing Address - Fax:
Practice Address - Street 1:55 E 92ND ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-1300
Practice Address - Country:US
Practice Address - Phone:212-360-6570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010646-1102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst