Provider Demographics
NPI:1568792935
Name:WHITE, FAY (MED)
Entity Type:Individual
Prefix:
First Name:FAY
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 ESMOND ST
Mailing Address - Street 2:
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02121-4006
Mailing Address - Country:US
Mailing Address - Phone:617-822-5133
Mailing Address - Fax:
Practice Address - Street 1:58 ESMOND ST
Practice Address - Street 2:
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02121-4006
Practice Address - Country:US
Practice Address - Phone:617-822-5133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-07
Last Update Date:2010-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health