Basic Information
| Provider Information | |||||||||
| NPI: | 1255574273 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WHITTLESEY | ||||||||
| FirstName: | CHLOE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MISS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 126 W 25TH AVE | ||||||||
| Address2: | SUITE #202 | ||||||||
| City: | SAN MATEO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 944032208 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6502862090 | ||||||||
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| Practice Location | |||||||||
| Address1: | 126 W 25TH AVENUE | ||||||||
| Address2: | SUITE #202 | ||||||||
| City: | SAN MATEO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 944032208 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6502862090 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/07/2009 | ||||||||
| LastUpdateDate: | 04/05/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.