Provider Demographics
NPI:1659712735
Name:WHITE, MARNEY A (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARNEY
Middle Name:A
Last Name:WHITE
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 1:301 CEDAR ST FL 2
Mailing Address - Street 2:PO BOX 208098
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06519-1638
Mailing Address - Country:US
Mailing Address - Phone:203-785-4349
Mailing Address - Fax:203-785-7855
Practice Address - Street 1:301 CEDAR ST FL 2
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06519-1638
Practice Address - Country:US
Practice Address - Phone:203-785-4349
Practice Address - Fax:203-785-7855
Is Sole Proprietor?:No
Enumeration Date:2013-07-17
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002731103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical