MEDICARE: DAVID L WHITAKER PHD

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	012082	NY
2	103TC0700X	Clinical Psychologist	012082	NY
3	103TP2701X	Group Psychotherapy Psychologist	012082	NY
4	103TF0000X	Family Psychologist	012082	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	012082	OTHER	NY	LICENSE

General Provider Information

NPI Number	:	1770691420
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID L WHITAKER PHD

Provider Business Mailing Address
First Line	:	8701 SHORE RD APT 330
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11209-4234
Country	:	US
Telephone Number	:	917-626-4687
Fax Number	:	718-832-4683

Provider Business Practice Location Address
First Line	:	26 COURT ST STE 504
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11242-1105
Country	:	US
Telephone Number	:	917-626-4687
Fax Number	:	718-832-6843

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

Provider Enumeration Date	:	08/25/2006
Last Update Date	:	09/11/2025

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Directions to “ DAVID L WHITAKER PHD” Practice Location

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