Provider Demographics
NPI:1770691420
Name:WHITAKER, DAVID L (PHD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:L
Last Name:WHITAKER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8701 SHORE RD APT 330
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-4234
Mailing Address - Country:US
Mailing Address - Phone:917-626-4687
Mailing Address - Fax:718-832-4683
Practice Address - Street 1:26 COURT ST STE 504
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11242-1105
Practice Address - Country:US
Practice Address - Phone:917-626-4687
Practice Address - Fax:718-832-6843
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012082103T00000X, 103TC0700X, 103TP2701X, 103TF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
Not Answered103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY012082OtherLICENSE