Active NPI
Matthew L Whitehead, PSY.D.
- Clinical Psychologist
- Philadelphia, PA
National Provider Identifier
1568608024
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PS016572
- Practice address
- 255 S 17TH St
Suite 2510
Philadelphia, PA 19103-6231 - Phone
- (610) 566-8357
- NPI assigned
- Jan 5, 2009
- 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 | PS016572 | PA | Primary |
Addresses
Primary practice location
255 S 17TH St
Suite 2510
Philadelphia, PA 19103-6231
Mailing address
412 N Jackson St Apt 3a
Media, PA 19063-2818
Phone (610) 566-8357
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in PA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20090220000224 | PA | Practitioner - Clinical Psychologist | 8325103617 | Practice locations: Philadelphia, PA |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Psychologist
- Education
- Other, 2007
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
1601 Walnut St
Suite 1307
Philadelphia, PA 19102-2908
Phone (610) 566-8357
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PS016572 | PA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1231113600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1245283200000",
"number": "1568608024",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "412 N JACKSON ST APT 3A",
"city": "MEDIA",
"state": "PA",
"postal_code": "190632818",
"telephone_number": "610-566-8357"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "255 S 17TH ST",
"address_2": "SUITE 2510",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191036231",
"telephone_number": "610-566-8357"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WHITEHEAD",
"first_name": "MATTHEW",
"middle_name": "L",
"name_prefix": "Dr.",
"credential": "PSY.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-01-05",
"last_updated": "2009-06-18",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "PA",
"license": "PS016572",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Philadelphia, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.