Healthcare Provider Details

I. General information

NPI: 1801934286
Provider Name (Legal Business Name): HEIDI E HUTTON PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N WOLFE ST DEPT OF PSYCHIATRY MEYER 3-143
BALTIMORE MD
21287-0005
US

IV. Provider business mailing address

600 N WOLFE ST DEPT OF PSYCHIATRY MEYER 3-143
BALTIMORE MD
21287-0005
US

V. Phone/Fax

Practice location:
  • Phone: 443-287-2874
  • Fax: 410-955-6901
Mailing address:
  • Phone: 443-287-2874
  • Fax: 410-955-6901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2826
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: