Provider Demographics
NPI:1427555341
Name:WHALEN, JOHN R (MS)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:R
Last Name:WHALEN
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4091 NE CHERI DR
Mailing Address - Street 2:
Mailing Address - City:JENSEN BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:34957-3819
Mailing Address - Country:US
Mailing Address - Phone:772-334-8343
Mailing Address - Fax:
Practice Address - Street 1:4091 NE CHERI DR
Practice Address - Street 2:
Practice Address - City:JENSEN BEACH
Practice Address - State:FL
Practice Address - Zip Code:34957-3819
Practice Address - Country:US
Practice Address - Phone:772-334-8343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-08
Last Update Date:2018-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)