Provider Demographics
NPI:1598111593
Name:WHALEN, WILLIAM V (LADC II)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:
Last Name:WHALEN
Suffix:V
Gender:M
Credentials:LADC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:182 POWDER HOUSE BLVD
Mailing Address - Street 2:2
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02144-1530
Mailing Address - Country:US
Mailing Address - Phone:617-371-1859
Mailing Address - Fax:
Practice Address - Street 1:17 COURT ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02108-2601
Practice Address - Country:US
Practice Address - Phone:617-371-1859
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-09
Last Update Date:2016-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAS77198020101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA$$$$$$$$$OtherSS