Healthcare Provider Details

I. General information

NPI: 1639473986
Provider Name (Legal Business Name): SCOTT POLLAK HYKIN PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/30/2010
Last Update Date: 08/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6917 ARLINGTON RD SUITE 225
BETHESDA MD
20814-5211
US

IV. Provider business mailing address

6917 ARLINGTON RD SUITE 225
BETHESDA MD
20814-5211
US

V. Phone/Fax

Practice location:
  • Phone: 301-801-4543
  • Fax:
Mailing address:
  • Phone: 301-801-4543
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number04203
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number04203
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number04203
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number0810004674
License Number StateVA
# 5
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0810004674
License Number StateVA
# 6
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number0810004674
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: