Healthcare Provider Details

I. General information

NPI: 1871925537
Provider Name (Legal Business Name): JUETA MCCUTCHAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2013
Last Update Date: 09/11/2025
Certification Date: 10/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1078 MALAEIMI STREET
PAGO PAGO AMERICAN SAMOA
96799
UM

IV. Provider business mailing address

PO BOX 1078
PAGO PAGO AS
96799-1078
US

V. Phone/Fax

Practice location:
  • Phone: 684-699-9185
  • Fax:
Mailing address:
  • Phone: 684-699-9185
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number4083-C
License Number StateAS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: