Provider Demographics
NPI:1679778575
Name:WHITTEMORE, RICHERD (MSW)
Entity type:Individual
Prefix:
First Name:RICHERD
Middle Name:
Last Name:WHITTEMORE
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2398 PINEWAY DR
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33415-7227
Mailing Address - Country:US
Mailing Address - Phone:561-967-2566
Mailing Address - Fax:561-967-4556
Practice Address - Street 1:3898 VIA POINCIANA
Practice Address - Street 2:SUITE 13
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33467-2951
Practice Address - Country:US
Practice Address - Phone:561-967-2566
Practice Address - Fax:561-967-4556
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-19
Last Update Date:2009-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW19571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ3253Medicare ID - Type UnspecifiedLCSW