Healthcare Provider Details

I. General information

NPI: 1801618210
Provider Name (Legal Business Name): MELISSA SHRIVER HUTCHINS M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2024
Last Update Date: 10/28/2024
Certification Date: 10/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6073 DEER CREEK DR
PITTSVILLE MD
21850-1311
US

IV. Provider business mailing address

6073 DEER CREEK DR
PITTSVILLE MD
21850-1311
US

V. Phone/Fax

Practice location:
  • Phone: 301-503-3180
  • Fax:
Mailing address:
  • Phone: 301-503-3180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number1001647915
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: