| Doctor Name: | DR. JESSE WHITEHEAD |
| NPI Number: | 1225189152 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PSY.D |
| License Number: | 35SI00208700 |
| Business Practice Address: | 15 Canterbury Ln Tinton Falls, NJ - 077242804 |
| Business Phone Number: | 7325425925 |
| Business Fax Number: | 7325425841 |
| Mailing Address: | 15 Canterbury Ln, TINTON FALLS |
| State: | NJ |
| Postal Code: | 077242804 |
| Phone Number: | 7325425925 |
| Fax Number: | 7325425841 |
| NPI Enumeration Date: | 01/16/2007 |
| NPI Last Update Date: | 07/09/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | 35SI00208700 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NJ |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |