Healthcare Provider Details

I. General information

NPI: 1932240348
Provider Name (Legal Business Name): MICHAEL C HEITT PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 RESERVOIR CIR SUITE 201
BALTIMORE MD
21208-6374
US

IV. Provider business mailing address

8507 WESTFORD RD
LUTHERVILLE MD
21093-3932
US

V. Phone/Fax

Practice location:
  • Phone: 410-580-9047
  • Fax: 410-580-9046
Mailing address:
  • Phone: 410-823-3736
  • Fax: 410-580-9046

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number3448
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: