MEDICARE: DR. ERIN ELISE WHITE PSYD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TF0200X	Forensic Psychologist	021638	NY
2	390200000X	Student in an Organized Health Care Education/Training Program
3	103TF0200X	Forensic Psychologist	P.07934	OH

General Provider Information

NPI Number	:	1467733956
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERIN ELISE WHITE PSYD

Provider Business Mailing Address
First Line	:	320 COVENTRY CT APT 654
Second Line	:
City	:	PERRYSBURG
State	:	OH
Zip	:	43551-1269
Country	:	US
Telephone Number	:	269-317-5402
Fax Number	:

Provider Business Practice Location Address
First Line	:	3081 SULLIVANT AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43204-1831
Country	:	US
Telephone Number	:	614-278-0200
Fax Number	:	614-274-0937

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/29/2011
Last Update Date	:	10/18/2021

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