Provider Demographics
NPI:1902235039
Name:WHITTEN, REBECCA LANDES (PSYD)
Entity type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:LANDES
Last Name:WHITTEN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 HUMPHREYS AVE
Mailing Address - Street 2:
Mailing Address - City:PENNSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08070-1116
Mailing Address - Country:US
Mailing Address - Phone:856-678-6954
Mailing Address - Fax:
Practice Address - Street 1:6 HUMPHREYS AVE
Practice Address - Street 2:
Practice Address - City:PENNSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08070-1116
Practice Address - Country:US
Practice Address - Phone:856-678-6954
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-08
Last Update Date:2013-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ5111103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical