Provider Demographics
NPI:1104832674
Name:HESTICK PSYCHOLOGICAL SERVICES, P.A.
Entity Type:Organization
Organization Name:HESTICK PSYCHOLOGICAL SERVICES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HENRIETTA
Authorized Official - Middle Name:
Authorized Official - Last Name:HESTICK
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:410-944-4400
Mailing Address - Street 1:7501 LIBERTY RD STE G
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21207-3870
Mailing Address - Country:US
Mailing Address - Phone:410-944-4400
Mailing Address - Fax:
Practice Address - Street 1:7501 LIBERTY RD STE G
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21207-3870
Practice Address - Country:US
Practice Address - Phone:410-944-4400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD02130103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD214517OtherALLIANCE/VALUE OPTIONS
MD1G269OtherCAREFIRST/ BLUE CROSS BLU