Provider Demographics
NPI:1891702494
Name:WHITE, DEBORAH O (PHD)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:O
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 1:14 BAYBERRY LN
Mailing Address - Street 2:
Mailing Address - City:COHASSET
Mailing Address - State:MA
Mailing Address - Zip Code:02025-1606
Mailing Address - Country:US
Mailing Address - Phone:617-626-8642
Mailing Address - Fax:
Practice Address - Street 1:25 STANIFORD ST
Practice Address - Street 2:PLAZA LEVEL
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2503
Practice Address - Country:US
Practice Address - Phone:617-626-8642
Practice Address - Fax:617-626-8669
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8533103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic