MEDICARE: RICHARD WHITTEMORE PA

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	101YM0800X	Mental Health Counselor	SW001957	FL

General Provider Information

NPI Number	:	1831295559
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RICHARD WHITTEMORE PA

Provider Business Mailing Address
First Line	:	3898 VIA POINCIANA
Second Line	:	SUITE 13
City	:	LAKE WORTH
State	:	FL
Zip	:	33467-2951
Country	:	US
Telephone Number	:	561-967-2566
Fax Number	:	561-967-4556

Provider Business Practice Location Address
First Line	:	3898 VIA POINCIANA
Second Line	:	SUITE 13
City	:	LAKE WORTH
State	:	FL
Zip	:	33467-2951
Country	:	US
Telephone Number	:	561-967-2566
Fax Number	:	561-967-4556

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. RICHERD WHITTEMORE
Credential	:	LCSW
Telephone Number	:	561-967-2566

Provider Enumeration Date	:	09/16/2006
Last Update Date	:	07/20/2009

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