Provider Demographics
NPI:1972225092
Name:BAMBERG, WHITNEY JANIQUE
Entity Type:Individual
Prefix:
First Name:WHITNEY
Middle Name:JANIQUE
Last Name:BAMBERG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 PARK AVE APT 6M
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10456-4582
Mailing Address - Country:US
Mailing Address - Phone:347-664-2583
Mailing Address - Fax:
Practice Address - Street 1:2417 3RD AVE STE 701
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451-6342
Practice Address - Country:US
Practice Address - Phone:929-613-1737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-15
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health