Provider Demographics
NPI:1144382839
Name:WHITE, ROGER H JR (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:H
Last Name:WHITE
Suffix:JR
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3029 LA MANCHA CT NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87104-3015
Mailing Address - Country:US
Mailing Address - Phone:505-843-9379
Mailing Address - Fax:
Practice Address - Street 1:3029 LA MANCHA CT NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87104-3015
Practice Address - Country:US
Practice Address - Phone:505-843-9379
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM309103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist