Provider Demographics
NPI:1750890356
Name:WHITE, TONYA (LMHC)
Entity type:Individual
Prefix:
First Name:TONYA
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 HASKELL ST # 1
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02140-1915
Mailing Address - Country:US
Mailing Address - Phone:978-491-8323
Mailing Address - Fax:
Practice Address - Street 1:60 MAPLE ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:MA
Practice Address - Zip Code:01062-1205
Practice Address - Country:US
Practice Address - Phone:617-600-8952
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-26
Last Update Date:2017-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10315101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA10315OtherBOARD OF ALLIED MENTAL HEALTH