Provider Demographics
NPI:1679619746
Name:WHITMORE, JANE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JANE
Middle Name:
Last Name:WHITMORE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:86 SABINO GONZALES RD
Mailing Address - Street 2:
Mailing Address - City:GLORIETA
Mailing Address - State:NM
Mailing Address - Zip Code:87535-7070
Mailing Address - Country:US
Mailing Address - Phone:505-473-9881
Mailing Address - Fax:
Practice Address - Street 1:1640 OLD PECOS TRL STE B
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-4777
Practice Address - Country:US
Practice Address - Phone:505-473-9881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2013-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM455103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist