Healthcare Provider Details

I. General information

NPI: 1073022273
Provider Name (Legal Business Name): ABIGAIL GRACE HOTTER PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2017
Last Update Date: 06/03/2025
Certification Date: 06/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1239 ARDEN RD
PASADENA CA
91106-4135
US

IV. Provider business mailing address

PO BOX 61096
PASADENA CA
91116-7096
US

V. Phone/Fax

Practice location:
  • Phone: 310-929-0033
  • Fax:
Mailing address:
  • Phone: 323-413-7348
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number33323
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: