Provider Demographics
NPI:1558978338
Name:WHITE, EMILY J (LMSW, CMC)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:J
Last Name:WHITE
Suffix:
Gender:F
Credentials:LMSW, CMC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1225 VIENNA DR SPC 292
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94089-1833
Mailing Address - Country:US
Mailing Address - Phone:650-766-7467
Mailing Address - Fax:
Practice Address - Street 1:1225 VIENNA DR SPC 292
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94089-1833
Practice Address - Country:US
Practice Address - Phone:650-766-7467
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-25
Last Update Date:2020-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95233104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker