Basic Information
| Provider Information | |||||||||
| NPI: | 1932247640 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WHITELEY | ||||||||
| FirstName: | LAURA | ||||||||
| MiddleName: | BRAVE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 593 EDDY ST | ||||||||
| Address2: | APC 978 | ||||||||
| City: | PROVIDENCE | ||||||||
| State: | RI | ||||||||
| PostalCode: | 029034923 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4014444318 | ||||||||
| FaxNumber: | 4014447865 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 HOPPIN ST | ||||||||
| Address2: | SUITE 204 | ||||||||
| City: | PROVIDENCE | ||||||||
| State: | RI | ||||||||
| PostalCode: | 029034141 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4014448945 | ||||||||
| FaxNumber: | 4014448742 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/02/2007 | ||||||||
| LastUpdateDate: | 07/29/2011 | ||||||||
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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 | 2084P0804X | MD13728 | RI | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Child & Adolescent Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | MD13728 | 01 | RI | MEDICAL LICENSE | OTHER |