Healthcare Provider Details

I. General information

NPI: 1811562325
Provider Name (Legal Business Name): JACQUELINE HYMAN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2021
Last Update Date: 05/26/2021
Certification Date: 05/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 N POTOMAC ST
BALTIMORE MD
21224-1336
US

IV. Provider business mailing address

33 N POTOMAC ST
BALTIMORE MD
21224-1336
US

V. Phone/Fax

Practice location:
  • Phone: 443-852-9614
  • Fax:
Mailing address:
  • Phone: 443-852-9614
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code103TE1100X
TaxonomyExercise & Sports Psychologist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: