Doctor Name: | LISA JEAN WHOLEY |
NPI Number: | 1124493994 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PH.D |
License Number: | |
Business Practice Address: | 43 Broad St Westerly, RI - 028911977 |
Business Phone Number: | 4013154847 |
Business Fax Number: | 4015960088 |
Mailing Address: | 43 Broad St, WESTERLY |
State: | RI |
Postal Code: | 028911977 |
Phone Number: | 4013154847 |
Fax Number: | 4015960088 |
NPI Enumeration Date: | 12/04/2015 |
NPI Last Update Date: | 12/04/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC2200X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical Child & Adolescent |
Taxonomy Definition: |