Healthcare Provider Details

I. General information

NPI: 1437065356
Provider Name (Legal Business Name): LAURIE WHITTEMORE PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1610 BIRD AVE
SAN JOSE CA
95125-1821
US

IV. Provider business mailing address

14590 HOMERITE DR
SAN JOSE CA
95124-2903
US

V. Phone/Fax

Practice location:
  • Phone: 408-535-6671
  • Fax:
Mailing address:
  • Phone: 408-472-9802
  • Fax: 999-999-9999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: