Provider Demographics
NPI:1255599551
Name:WHITE, ALAN ANTHONY (MA)
Entity type:Individual
Prefix:MR
First Name:ALAN
Middle Name:ANTHONY
Last Name:WHITE
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5000 BROADWAY
Mailing Address - Street 2:APT 3C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10034-1602
Mailing Address - Country:US
Mailing Address - Phone:917-841-1381
Mailing Address - Fax:
Practice Address - Street 1:119 W 57TH ST
Practice Address - Street 2:SUITE 1100
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-2303
Practice Address - Country:US
Practice Address - Phone:212-757-4488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-23
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY6006683UPD101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health