Healthcare Provider Details

I. General information

NPI: 1144690892
Provider Name (Legal Business Name): PATRICK WHALEN PHD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2015
Last Update Date: 10/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 HAMILTON AVE STE 140
PALO ALTO CA
94301-2043
US

IV. Provider business mailing address

550 HAMILTON AVE STE 140
PALO ALTO CA
94301-2043
US

V. Phone/Fax

Practice location:
  • Phone: 650-735-1449
  • Fax:
Mailing address:
  • Phone: 650-735-1449
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberPSY25234
License Number StateCA

VIII. Authorized Official

Name: DR. PATRICK KENNETH WHALEN
Title or Position: PSYCHOLOGIST
Credential: PHD
Phone: 650-735-1449