Healthcare Provider Details

I. General information

NPI: 1134942055
Provider Name (Legal Business Name): JO-ANNE AGUIRRE PUTCH MA, CAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2024
Last Update Date: 11/07/2024
Certification Date: 11/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3223 E PRATT ST
BALTIMORE MD
21224-2359
US

IV. Provider business mailing address

9303 RAVENRIDGE RD
BALTIMORE MD
21234-1453
US

V. Phone/Fax

Practice location:
  • Phone: 410-396-9381
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: