Provider Demographics
NPI:1194865923
Name:WHITESIDE, BARBARA DENISE (PHD)
Entity Type:Individual
Prefix:DR
First Name:BARBARA
Middle Name:DENISE
Last Name:WHITESIDE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 CLEARBROOK DR
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-4805
Mailing Address - Country:US
Mailing Address - Phone:631-979-9664
Mailing Address - Fax:
Practice Address - Street 1:10 CLEARBROOK DR
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-4805
Practice Address - Country:US
Practice Address - Phone:631-979-9664
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY9070-1103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY61-52350OtherUNITED BEHAVIORAL HEALTH
NY085964OtherVALUEOPTIONS
NY61-52350OtherUNITED BEHAVIORAL HEALTH