Healthcare Provider Details

I. General information

NPI: 1033713227
Provider Name (Legal Business Name): BRIAN WHITAKER CPS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2020
Last Update Date: 07/15/2021
Certification Date: 07/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 E 14TH ST
HISTORIC NEW CASTLE DE
19720-4510
US

IV. Provider business mailing address

302 E 14TH ST
HISTORIC NEW CASTLE DE
19720-4510
US

V. Phone/Fax

Practice location:
  • Phone: 302-328-8633
  • Fax:
Mailing address:
  • Phone: 302-328-8633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number1649
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: