Healthcare Provider Details

I. General information

NPI: 1073072732
Provider Name (Legal Business Name): JACLYN HUTCHINSON LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2019
Last Update Date: 03/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4940 EASTERN AVE COMMUNITY PSYCHIATRY PROGRAM
BALTIMORE MD
21224
US

IV. Provider business mailing address

4940 EASTERN AVE COMMUNITY PSYCHIATRY PROGRAM
BALTIMORE MD
21224
US

V. Phone/Fax

Practice location:
  • Phone: 410-550-2996
  • Fax:
Mailing address:
  • Phone: 410-550-2996
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number19118
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: