Provider Demographics
NPI:1932325495
Name:WHITE, DEBORAH D (PHD)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:D
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 1:3300 LYNDALE AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55408-3656
Mailing Address - Country:US
Mailing Address - Phone:612-817-4397
Mailing Address - Fax:
Practice Address - Street 1:3300 LYNDALE AVE S
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55408-3656
Practice Address - Country:US
Practice Address - Phone:612-817-4397
Practice Address - Fax:952-746-4252
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP3937103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN42P38WHOtherBLUE CROSS OF MN CLINIC #