Healthcare Provider Details

I. General information

NPI: 1164026555
Provider Name (Legal Business Name): MARY ANN YUTZY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/25/2020
Last Update Date: 11/25/2020
Certification Date: 11/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7484 SHAWNEE RD
MILFORD DE
19963-3521
US

IV. Provider business mailing address

7484 SHAWNEE RD
MILFORD DE
19963-3521
US

V. Phone/Fax

Practice location:
  • Phone: 302-573-1247
  • Fax:
Mailing address:
  • Phone: 302-573-1247
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: