Healthcare Provider Details

I. General information

NPI: 1447309422
Provider Name (Legal Business Name): GERALD PATRICK WHITMORE PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 01/03/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 W MACARTHUR BLVD
OAKLAND CA
94611-5642
US

IV. Provider business mailing address

280 W MACARTHUR BLVD
OAKLAND CA
94611-5642
US

V. Phone/Fax

Practice location:
  • Phone: 510-752-1457
  • Fax: 510-752-1404
Mailing address:
  • Phone: 510-752-1457
  • Fax: 510-752-1404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPSY14672
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: