Provider Demographics
NPI:1710901749
Name:WHITE, TANYA B (PHD)
Entity Type:Individual
Prefix:DR
First Name:TANYA
Middle Name:B
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 1:9 DORAN FARM LN
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02420-2128
Mailing Address - Country:US
Mailing Address - Phone:781-862-6490
Mailing Address - Fax:781-860-9429
Practice Address - Street 1:9 DORAN FARM LN
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02420-2128
Practice Address - Country:US
Practice Address - Phone:781-862-6490
Practice Address - Fax:781-860-9429
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3478103TF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAWO3533Medicare ID - Type UnspecifiedPSYCHOLOGIST