Provider Demographics
NPI:1386461069
Name:WHITE, TAYLOR (LMSW)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:564 CASWELL RD
Mailing Address - Street 2:
Mailing Address - City:FREEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13068-9407
Mailing Address - Country:US
Mailing Address - Phone:607-227-0218
Mailing Address - Fax:
Practice Address - Street 1:905 HANSHAW RD STE C
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-1549
Practice Address - Country:US
Practice Address - Phone:607-277-2170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-24
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY103506104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker