Provider Demographics
NPI:1225146772
Name:WHITT, CAROLYN REHADA (MS)
Entity Type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:REHADA
Last Name:WHITT
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2219 MARIETTA AVE
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17603-2221
Mailing Address - Country:US
Mailing Address - Phone:717-397-7710
Mailing Address - Fax:717-393-8463
Practice Address - Street 1:2219 MARIETTA AVE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17603-2221
Practice Address - Country:US
Practice Address - Phone:717-397-7710
Practice Address - Fax:717-393-8463
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS006994L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA754307Medicare UPIN