Healthcare Provider Details

I. General information

NPI: 1619626512
Provider Name (Legal Business Name): DR. HEIDI HUTMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2022
Last Update Date: 03/20/2022
Certification Date: 03/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 AUTUMN CT
CHERRY HILL NJ
08003-3013
US

IV. Provider business mailing address

9 AUTUMN CT
CHERRY HILL NJ
08003-3013
US

V. Phone/Fax

Practice location:
  • Phone: 518-256-7666
  • Fax:
Mailing address:
  • Phone: 518-256-7666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPS019486
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: