Healthcare Provider Details

I. General information

NPI: 1770691420
Provider Name (Legal Business Name): DAVID L WHITAKER PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 COURT ST STE 504
BROOKLYN NY
11242-1105
US

IV. Provider business mailing address

8701 SHORE RD APT 330
BROOKLYN NY
11209-4234
US

V. Phone/Fax

Practice location:
  • Phone: 917-626-4687
  • Fax: 718-832-6843
Mailing address:
  • Phone: 917-626-4687
  • Fax: 718-832-4683

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number012082
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number012082
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number012082
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number012082
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: