Provider Demographics
NPI:1063781359
Name:WHITE, REBA JEAN (PHD)
Entity type:Individual
Prefix:DR
First Name:REBA
Middle Name:JEAN
Last Name:WHITE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 LIVORNO RD
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95341-7754
Mailing Address - Country:US
Mailing Address - Phone:209-383-5109
Mailing Address - Fax:
Practice Address - Street 1:80 LIVORNO RD
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95341-7754
Practice Address - Country:US
Practice Address - Phone:209-383-5109
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-15
Last Update Date:2018-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY10225103T00000X, 103TC0700X
MS20-250103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist