Provider Demographics
NPI:1992948012
Name:WHITAKER, WARREN EDWARD (MSED)
Entity type:Individual
Prefix:MR
First Name:WARREN
Middle Name:EDWARD
Last Name:WHITAKER
Suffix:
Gender:M
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6218 S 7TH ST
Mailing Address - Street 2:BUILDING A
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85042-4211
Mailing Address - Country:US
Mailing Address - Phone:602-243-4866
Mailing Address - Fax:602-341-3132
Practice Address - Street 1:6218 S 7TH ST
Practice Address - Street 2:BUILDING A
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85042-4211
Practice Address - Country:US
Practice Address - Phone:602-243-4866
Practice Address - Fax:602-341-3132
Is Sole Proprietor?:No
Enumeration Date:2009-04-20
Last Update Date:2009-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4083117103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool