Provider Demographics
NPI:1598868432
Name:WHATLEY, RENEE JOANNA (MA)
Entity Type:Individual
Prefix:MS
First Name:RENEE
Middle Name:JOANNA
Last Name:WHATLEY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3900 CITY AVE.
Mailing Address - Street 2:PRESIDENTIAL-MADISON HOUSE, SUITE D-105
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19131
Mailing Address - Country:US
Mailing Address - Phone:215-472-6454
Mailing Address - Fax:215-878-4622
Practice Address - Street 1:3900 CITY AVE
Practice Address - Street 2:PRESIDENTIAL-MADISON HOUSE, SUITE D-105
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19131-2908
Practice Address - Country:US
Practice Address - Phone:215-472-6454
Practice Address - Fax:215-878-4622
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS-005216-L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist