Provider Demographics
NPI:1023296308
Name:WHITEHOUSE, AMANDA RENE DESIO (PHD)
Entity type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:RENE DESIO
Last Name:WHITEHOUSE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:RENE
Other - Last Name:DESIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:5949 CAMP RD
Mailing Address - Street 2:#1164
Mailing Address - City:HAMBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14075
Mailing Address - Country:US
Mailing Address - Phone:716-249-0500
Mailing Address - Fax:716-427-2782
Practice Address - Street 1:5949 CAMP RD #1164
Practice Address - Street 2:
Practice Address - City:HAMBURG
Practice Address - State:NY
Practice Address - Zip Code:14075
Practice Address - Country:US
Practice Address - Phone:716-249-0500
Practice Address - Fax:716-427-2782
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-08
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool