Healthcare Provider Details

I. General information

NPI: 1952540221
Provider Name (Legal Business Name): DR. BEVERLY WHITE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/11/2009
Last Update Date: 05/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1055 E BALTIMORE PIKE SUITE 300
MEDIA PA
19063-5173
US

IV. Provider business mailing address

1055 E BALTIMORE PIKE SUITE 300
MEDIA PA
19063-5173
US

V. Phone/Fax

Practice location:
  • Phone: 610-892-3800
  • Fax: 484-468-1412
Mailing address:
  • Phone: 610-892-3800
  • Fax: 484-468-1412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS016618
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW014716
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: