Healthcare Provider Details

I. General information

NPI: 1467809285
Provider Name (Legal Business Name): AMBER WHITE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2016
Last Update Date: 05/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 ATWOOD DR SUITE 301
NORTHAMPTON MA
01060-4266
US

IV. Provider business mailing address

109 BIRCH ST
WATERTOWN CT
06795-2758
US

V. Phone/Fax

Practice location:
  • Phone: 413-773-1314
  • Fax: 413-774-1197
Mailing address:
  • Phone: 860-307-7930
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: