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NPI Code Detail

MEDICARE: JOEL WHITLOCK

MEDICARE:   JOEL  WHITLOCK
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health CounselorP106484NY

General Provider Information

NPI Number : 1013502160
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOEL WHITLOCK
Provider Business Mailing Address
First Line : 36 SACHSON PL
Second Line :
City : WAPPINGERS FALLS
State : NY
Zip : 12590-3858
Country : US
Telephone Number : 845-264-2477
Fax Number :
Provider Business Practice Location Address
First Line : 36 SACHSON PL
Second Line :
City : WAPPINGERS FALLS
State : NY
Zip : 12590-3858
Country : US
Telephone Number : 845-264-2477
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/01/2021
Last Update Date : 03/01/2021

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