Healthcare Provider Details

I. General information

NPI: 1497189161
Provider Name (Legal Business Name): JAMES TIMOTHY WHITE MA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2013
Last Update Date: 08/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 BELMONT ST
WORCESTER MA
01604-1675
US

IV. Provider business mailing address

45 PROUTY LN
WORCESTER MA
01602-2251
US

V. Phone/Fax

Practice location:
  • Phone: 508-791-3261
  • Fax:
Mailing address:
  • Phone: 508-340-0529
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number199B0AF1-6E02-4452-8
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: