Provider Demographics
NPI:1932226537
Name:WHITE, MARGARET LEBO (PHD)
Entity Type:Individual
Prefix:MS
First Name:MARGARET
Middle Name:LEBO
Last Name:WHITE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 MONTCLAIR AVE
Mailing Address - Street 2:
Mailing Address - City:UPPER MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07043-1707
Mailing Address - Country:US
Mailing Address - Phone:973-746-5442
Mailing Address - Fax:
Practice Address - Street 1:212 MONTCLAIR AVE
Practice Address - Street 2:
Practice Address - City:UPPER MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07043-1707
Practice Address - Country:US
Practice Address - Phone:973-746-5442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJS101420103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ675018Medicare ID - Type Unspecified