Provider Demographics
NPI:1457669798
Name:WHALEN, JAMIE ANNETTE (PSYD)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:ANNETTE
Last Name:WHALEN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:ANNETTE
Other - Last Name:D'ORAZIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3651 E BASELINE RD STE E-204
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-2689
Mailing Address - Country:US
Mailing Address - Phone:480-272-4740
Mailing Address - Fax:480-633-7788
Practice Address - Street 1:3651 E BASELINE RD STE E-204
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-2689
Practice Address - Country:US
Practice Address - Phone:480-272-4740
Practice Address - Fax:480-633-7788
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-21
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSB-35421103TC2200X
390200000X
AZ4316103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program