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General NPI Number Information
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NPI Number | 1396262036
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Entity Type | Organization
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Legal Business Name | HALEY E KUTNER PHD LLC
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Dates
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Enumeration Date | 08/24/2017
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Last Update Date | 09/19/2017
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Provider Practice Location Address
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Address Line | 5821 STAPLES MILL RD
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City | RICHMOND
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State | VA
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Zip | 23228-5427
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Country | US
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Telephone | 804-264-0966
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Fax |
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Provider Business Mailing Address
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Address Line | 426 GEESE LNDG
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City | GLEN ALLEN
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State | VA
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Zip | 23060-5877
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST
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Name | HALEY KUTNER
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Credential | PHD
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Telephone | 201-349-6354
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 0810005445
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License Number State | VA
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