MEDICARE: KENNETH WHITTINGHAM

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
1	104100000X	Social Worker	094925	NY

General Provider Information

NPI Number	:	1467901256
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNETH WHITTINGHAM

Provider Business Mailing Address
First Line	:	4443 BAYCHESTER AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10466-1101
Country	:	US
Telephone Number	:	561-512-8071
Fax Number	:

Provider Business Practice Location Address
First Line	:	4443 BAYCHESTER AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10466
Country	:	US
Telephone Number	:	561-512-8071
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/22/2016
Last Update Date	:	09/22/2016

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Directions to “ KENNETH WHITTINGHAM ” Practice Location

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