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General NPI Number Information
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NPI Number | 1568608024
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Entity Type | Individual
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Provider Name | MATTHEW L WHITEHEAD PSY.D.
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Gender | Male
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Dates
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Enumeration Date | 01/05/2009
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Last Update Date | 06/18/2009
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Provider Practice Location Address
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Address Line | 255 S 17TH ST SUITE 2510
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City | PHILADELPHIA
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State | PA
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Zip | 19103-6231
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Country | US
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Telephone | 610-566-8357
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Fax |
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Provider Business Mailing Address
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Address Line | 412 N JACKSON ST APT 3A
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City | MEDIA
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State | PA
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Zip | 19063-2818
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Country | US
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Telephone | 610-566-8357
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | PS016572
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License Number State | PA
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