Active NPI
Jesse Whitehead Jr., PSY.D
- Clinical Psychologist
- Tinton Falls, NJ
National Provider Identifier
1225189152
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 35SI00208700
- Practice address
- 15 Canterbury LN
Tinton Falls, NJ 07724-2804 - Phone
- (732) 542-5925
- Fax
- (732) 542-5841
- NPI assigned
- Jan 16, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 35SI00208700 | NJ | Primary |
Addresses
Primary practice location
15 Canterbury LN
Tinton Falls, NJ 07724-2804
Mailing address
15 Canterbury LN
Tinton Falls, NJ 07724-2804
Phone (732) 542-5925
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3475107 | Medicaid | NJ |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168905600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1225189152",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15 CANTERBURY LN",
"city": "TINTON FALLS",
"state": "NJ",
"postal_code": "077242804",
"telephone_number": "732-542-5925",
"fax_number": "732-542-5841"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15 CANTERBURY LN",
"city": "TINTON FALLS",
"state": "NJ",
"postal_code": "077242804",
"telephone_number": "732-542-5925",
"fax_number": "732-542-5841"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WHITEHEAD",
"first_name": "JESSE",
"name_prefix": "Dr.",
"name_suffix": "Jr.",
"credential": "PSY.D",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-01-16",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NJ",
"license": "35SI00208700",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3475107",
"state": "NJ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Tinton Falls, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.