Provider Demographics
NPI:1053895409
Name:WHITE, JENNIFER CAMERON (PSYD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:CAMERON
Last Name:WHITE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 PARKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19803-5211
Mailing Address - Country:US
Mailing Address - Phone:302-743-3973
Mailing Address - Fax:
Practice Address - Street 1:1015 PARKSIDE DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19803-5211
Practice Address - Country:US
Practice Address - Phone:302-743-3973
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-21
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEB1-0001155103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist