Provider Demographics
NPI:1760634158
Name:WHITMAN, MICHAEL J (PSYD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:WHITMAN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 S BEVERLY DR STE 300
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-4309
Mailing Address - Country:US
Mailing Address - Phone:310-622-3695
Mailing Address - Fax:818-465-2038
Practice Address - Street 1:315 S BEVERLY DR STE 300
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-4309
Practice Address - Country:US
Practice Address - Phone:310-622-3695
Practice Address - Fax:818-465-2038
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-16
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21428103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist