Provider Demographics
NPI:1811526288
Name:SP WHITE PSYCHOLOGICAL SERVICES, LLC
Entity type:Organization
Organization Name:SP WHITE PSYCHOLOGICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:POLKOWSKI
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:732-573-4282
Mailing Address - Street 1:348 ESTATE POINT RD
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-2064
Mailing Address - Country:US
Mailing Address - Phone:732-573-4282
Mailing Address - Fax:
Practice Address - Street 1:TELETHERAPY - NEED ADDRESS PRIVATE -
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-2064
Practice Address - Country:US
Practice Address - Phone:732-573-4282
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-07
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty