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General NPI Number Information
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NPI Number | 1073887816
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Entity Type | Organization
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Legal Business Name | PAUL B. WHITTEMORE, PH.D., A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 02/24/2012
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Last Update Date | 02/24/2012
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Provider Practice Location Address
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Address Line | 1001 DOVE ST SUITE 145
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City | NEWPORT BEACH
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State | CA
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Zip | 92660-2838
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Country | US
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Telephone | 949-752-7753
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Fax | 949-752-6463
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Provider Business Mailing Address
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Address Line | 1001 DOVE ST SUITE 145
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City | NEWPORT BEACH
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State | CA
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Zip | 92660-2838
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Country | US
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Telephone | 949-752-7753
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Fax | 949-752-6463
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Authorized Official
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Title or Position | LICENSED PSYCHOLOGIST/PRESIDENT
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Name | DR. PAUL B. WHITTEMORE
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Credential | PH.D.
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Telephone | 949-752-7753
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY-11060
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License Number State | CA
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