Provider Demographics
NPI:1962905711
Name:WHITE, DENISE M (PHD, LCADC)
Entity type:Individual
Prefix:DR
First Name:DENISE
Middle Name:M
Last Name:WHITE
Suffix:
Gender:F
Credentials:PHD, LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 HALSTEAD ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07106-1102
Mailing Address - Country:US
Mailing Address - Phone:551-580-0128
Mailing Address - Fax:
Practice Address - Street 1:30 HALSTEAD ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07106-1102
Practice Address - Country:US
Practice Address - Phone:551-580-0128
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-16
Last Update Date:2018-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00226500103TA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)