Provider Demographics
NPI:1902846140
Name:WHITNEY, JOHN B (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:B
Last Name:WHITNEY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 W EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:HADDONFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:08033-2554
Mailing Address - Country:US
Mailing Address - Phone:856-795-8285
Mailing Address - Fax:
Practice Address - Street 1:25 W EUCLID AVE
Practice Address - Street 2:
Practice Address - City:HADDONFIELD
Practice Address - State:NJ
Practice Address - Zip Code:08033-2554
Practice Address - Country:US
Practice Address - Phone:856-795-8285
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS 003700 L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1366057OtherBLUE CROSS/BLUE SHIELD
PA0019019050002Medicaid
PA057489Medicare ID - Type Unspecified