MEDICARE: DR. CARON DEBORAH WHIPPLE 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	103TC0700X	Clinical Psychologist	PYO294	NV

General Provider Information

NPI Number	:	1871868067
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CARON DEBORAH WHIPPLE PH.D.

Provider Business Mailing Address
First Line	:	2620 REGATTA DR
Second Line	:	SUITE 212
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-6891
Country	:	US
Telephone Number	:	702-822-6675
Fax Number	:	702-998-0395

Provider Business Practice Location Address
First Line	:	2620 REGATTA DR
Second Line	:	SUITE 212
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-6891
Country	:	US
Telephone Number	:	702-822-6675
Fax Number	:	702-998-0395

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

Provider Enumeration Date	:	03/20/2012
Last Update Date	:	03/20/2012

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