Healthcare Provider Details

I. General information

NPI: 1790092724
Provider Name (Legal Business Name): AARON TODD HEATON PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2010
Last Update Date: 02/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

365 W PATRICK ST FL 205
FREDERICK MD
21701-4870
US

IV. Provider business mailing address

365 W PATRICK ST FL 205
FREDERICK MD
21701-4870
US

V. Phone/Fax

Practice location:
  • Phone: 703-304-8464
  • Fax:
Mailing address:
  • Phone: 703-304-8464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number4297
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number4297
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number4297
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number4297
License Number StateMD
# 5
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number4297
License Number StateMD
# 6
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number4297
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: