Provider Demographics
NPI:1629627914
Name:WHITHAM, SIENA ELIZABETH (PHD)
Entity Type:Individual
Prefix:DR
First Name:SIENA
Middle Name:ELIZABETH
Last Name:WHITHAM
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15814 WINCHESTER BLVD STE 105
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95030-3333
Mailing Address - Country:US
Mailing Address - Phone:413-345-5226
Mailing Address - Fax:
Practice Address - Street 1:15814 WINCHESTER BLVD STE 105
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95030-3333
Practice Address - Country:US
Practice Address - Phone:413-345-5226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-09
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY31047103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical