Provider Demographics
NPI:1225722838
Name:BARUTI-GOODWIN, AIJAH KAI (PHD)
Entity Type:Individual
Prefix:DR
First Name:AIJAH
Middle Name:KAI
Last Name:BARUTI-GOODWIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:AIJAH
Other - Middle Name:
Other - Last Name:GOODWIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:737 W LOMBARD ST FL 4
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-1009
Mailing Address - Country:US
Mailing Address - Phone:215-360-9573
Mailing Address - Fax:
Practice Address - Street 1:701 W PRATT ST FL 2
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1023
Practice Address - Country:US
Practice Address - Phone:410-328-6018
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-06
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD06873103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist