Provider Demographics
NPI:1376681825
Name:WHITE, STEPHEN M (PSYD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:M
Last Name:WHITE
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16496 BERNARDO CENTER DR
Mailing Address - Street 2:#307
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-2524
Mailing Address - Country:US
Mailing Address - Phone:619-673-1031
Mailing Address - Fax:760-433-5031
Practice Address - Street 1:16496 BERNARDO CENTER DR
Practice Address - Street 2:#307
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-2524
Practice Address - Country:US
Practice Address - Phone:619-673-1031
Practice Address - Fax:760-433-5031
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-04
Last Update Date:2007-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY20739103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical