Provider Demographics
NPI:1780239343
Name:WHITCOMB, KAITLYN ELIZABETH (PHD)
Entity type:Individual
Prefix:DR
First Name:KAITLYN
Middle Name:ELIZABETH
Last Name:WHITCOMB
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:KAIT
Other - Middle Name:
Other - Last Name:WHITCOMB
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:870 CLARK ST STE 1020
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-9270
Mailing Address - Country:US
Mailing Address - Phone:407-493-2238
Mailing Address - Fax:
Practice Address - Street 1:870 CLARK ST STE 1020
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-9270
Practice Address - Country:US
Practice Address - Phone:407-493-2238
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-09
Last Update Date:2019-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY10448103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical