Provider Demographics
NPI:1023457710
Name:WHITE, TRICIA
Entity type:Individual
Prefix:
First Name:TRICIA
Middle Name:
Last Name:WHITE
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 1:521 W 42ND ST
Mailing Address - Street 2:8C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10036-6203
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1100 CONEY ISLAND AVE
Practice Address - Street 2:3RD
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-2344
Practice Address - Country:US
Practice Address - Phone:718-434-1200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-17
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2346721174H00000X
174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No174H00000XOther Service ProvidersHealth Educator
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2346721OtherSPECIAL EDUCATION TEACHER
NY2346721OtherSPECIALIST