Healthcare Provider Details

I. General information

NPI: 1144246448
Provider Name (Legal Business Name): GEOFFREY E. PUTT PSY.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 10/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 PERKINS SQ
AKRON OH
44308-1063
US

IV. Provider business mailing address

1 PERKINS SQ
AKRON OH
44308-1063
US

V. Phone/Fax

Practice location:
  • Phone: 330-543-6080
  • Fax: 330-543-4271
Mailing address:
  • Phone: 330-543-6080
  • Fax: 330-543-4271

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number5941
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: