Provider Demographics
NPI:1053030478
Name:WHITE, ABBY IRENE (MA)
Entity type:Individual
Prefix:
First Name:ABBY
Middle Name:IRENE
Last Name:WHITE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 EDGEMERE RD APT 115
Mailing Address - Street 2:
Mailing Address - City:WEST ROXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02132-5340
Mailing Address - Country:US
Mailing Address - Phone:585-478-1331
Mailing Address - Fax:
Practice Address - Street 1:42 HIGH ST STE 2
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155-3864
Practice Address - Country:US
Practice Address - Phone:781-350-4430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-29
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist