Provider Demographics
NPI:1871782664
Name:WHITWORTH, DONALD RAY (PHD)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:RAY
Last Name:WHITWORTH
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74 WATER ST
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:RI
Mailing Address - Zip Code:02871-4113
Mailing Address - Country:US
Mailing Address - Phone:401-683-3063
Mailing Address - Fax:401-683-3893
Practice Address - Street 1:74 WATER ST
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:RI
Practice Address - Zip Code:02871-4113
Practice Address - Country:US
Practice Address - Phone:401-683-3063
Practice Address - Fax:401-683-3893
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-17
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPS00597103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI7827-8OtherBLUE CROSS BLUE SHIELD