Provider Demographics
NPI:1609925296
Name:WHITE, MARJORIE JEAN (MA, LABA)
Entity type:Individual
Prefix:
First Name:MARJORIE
Middle Name:JEAN
Last Name:WHITE
Suffix:
Gender:F
Credentials:MA, LABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 BOBALA RD
Mailing Address - Street 2:
Mailing Address - City:HOLYOKE
Mailing Address - State:MA
Mailing Address - Zip Code:01040-9632
Mailing Address - Country:US
Mailing Address - Phone:413-750-8314
Mailing Address - Fax:413-707-2362
Practice Address - Street 1:40 BOBALA RD
Practice Address - Street 2:
Practice Address - City:HOLYOKE
Practice Address - State:MA
Practice Address - Zip Code:01040-9632
Practice Address - Country:US
Practice Address - Phone:413-750-8314
Practice Address - Fax:413-707-2362
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1800103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst