Provider Demographics
NPI:1275596298
Name:DUTT, NANCY ELIZABETH (MA NCC LPC)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:ELIZABETH
Last Name:DUTT
Suffix:
Gender:F
Credentials:MA NCC LPC
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:ELIZABETH
Other - Last Name:BAEHM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:146 WEST BROAD ST
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18018
Mailing Address - Country:US
Mailing Address - Phone:610-865-2288
Mailing Address - Fax:610-865-8003
Practice Address - Street 1:146 WEST BROAD ST
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18018
Practice Address - Country:US
Practice Address - Phone:610-865-2288
Practice Address - Fax:610-865-8003
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC003599101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
U87933Medicare UPIN