Provider Demographics
NPI:1063955573
Name:WHITLEY, JENNIFER CAROL (LCAT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:CAROL
Last Name:WHITLEY
Suffix:
Gender:F
Credentials:LCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:COLD SPRING
Mailing Address - State:NY
Mailing Address - Zip Code:10516-3013
Mailing Address - Country:US
Mailing Address - Phone:845-265-1085
Mailing Address - Fax:845-739-1096
Practice Address - Street 1:26 MAIN ST
Practice Address - Street 2:
Practice Address - City:COLD SPRING
Practice Address - State:NY
Practice Address - Zip Code:10516-3013
Practice Address - Country:US
Practice Address - Phone:845-265-1085
Practice Address - Fax:845-739-1096
Is Sole Proprietor?:No
Enumeration Date:2016-12-01
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001777-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health