Provider Demographics
NPI:1134674138
Name:WHITE, DEVIN AMMAN (LCSW)
Entity Type:Individual
Prefix:
First Name:DEVIN
Middle Name:AMMAN
Last Name:WHITE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 BALDWIN ST
Mailing Address - Street 2:
Mailing Address - City:PISCATAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08854-2336
Mailing Address - Country:US
Mailing Address - Phone:908-239-1462
Mailing Address - Fax:
Practice Address - Street 1:68 N BRIDGE ST
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08876-1953
Practice Address - Country:US
Practice Address - Phone:908-448-2741
Practice Address - Fax:908-698-0755
Is Sole Proprietor?:No
Enumeration Date:2016-08-19
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
NJ44SC058818001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker