Provider Demographics
NPI:1437543477
Name:HIATT, PAUL (PSYD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:
Last Name:HIATT
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:554E HEWSON ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19125-2435
Mailing Address - Country:US
Mailing Address - Phone:267-571-9643
Mailing Address - Fax:866-424-5162
Practice Address - Street 1:1420 WALNUT ST 1206
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19102-4012
Practice Address - Country:US
Practice Address - Phone:267-571-9643
Practice Address - Fax:866-424-5162
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-27
Last Update Date:2015-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS017833103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical