Healthcare Provider Details

I. General information

NPI: 1649717042
Provider Name (Legal Business Name): CASSANDRA HUTCHINS PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2017
Last Update Date: 06/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 MORRIS TPKE FL 4
SHORT HILLS NJ
07078-2625
US

IV. Provider business mailing address

830 MORRIS TPKE FL 4
SHORT HILLS NJ
07078-2625
US

V. Phone/Fax

Practice location:
  • Phone: 862-800-7406
  • Fax: 862-205-2466
Mailing address:
  • Phone: 862-800-7406
  • Fax: 862-205-2466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number163107
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number163107
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License Number163107
License Number StateNJ
# 4
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6032
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: