MEDICARE: DR. RICHARD K WHITE PH.D

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	103T00000X	Psychologist	00647	ME

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1659350098
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD K WHITE PH.D

Provider Business Mailing Address
First Line	:	26 EDES RD
Second Line	:
City	:	CUMBERLAND
State	:	ME
Zip	:	04021-4101
Country	:	US
Telephone Number	:	207-829-6912
Fax Number	:

Provider Business Practice Location Address
First Line	:	510 MAIN ST
Second Line	:
City	:	GORHAM
State	:	ME
Zip	:	04038-1339
Country	:	US
Telephone Number	:	207-839-6061
Fax Number	:

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

Provider Enumeration Date	:	01/13/2006
Last Update Date	:	12/28/2012

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Directions to “ DR. RICHARD K WHITE PH.D” Practice Location

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