Provider Demographics
NPI:1558640920
Name:WHITEHEAD, LINDA DEE (SE)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:DEE
Last Name:WHITEHEAD
Suffix:
Gender:F
Credentials:SE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 DODD ST
Mailing Address - Street 2:
Mailing Address - City:WEEHAWKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07086-5616
Mailing Address - Country:US
Mailing Address - Phone:917-509-5027
Mailing Address - Fax:
Practice Address - Street 1:118 DODD ST
Practice Address - Street 2:
Practice Address - City:WEEHAWKEN
Practice Address - State:NJ
Practice Address - Zip Code:07086-5616
Practice Address - Country:US
Practice Address - Phone:917-509-5027
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-16
Last Update Date:2011-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY861025103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst