Provider Demographics
NPI:1194870550
Name:WHITTAKER, RUE HARRISON (MFT)
Entity type:Individual
Prefix:MS
First Name:RUE
Middle Name:HARRISON
Last Name:WHITTAKER
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:MS
Other - First Name:MARCIA RUE
Other - Middle Name:HARRISON
Other - Last Name:WHITTAKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MFT
Mailing Address - Street 1:516 OAKLAND AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94611-5429
Mailing Address - Country:US
Mailing Address - Phone:510-409-5459
Mailing Address - Fax:519-594-2526
Practice Address - Street 1:516 OAKLAND AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94611-5429
Practice Address - Country:US
Practice Address - Phone:510-409-5459
Practice Address - Fax:519-594-2526
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2016-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC38393106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist