Provider Demographics
NPI:1629521992
Name:JOHN M. HINTZE, PH.D. LLC
Entity Type:Organization
Organization Name:JOHN M. HINTZE, PH.D. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:HINTZE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:860-281-1419
Mailing Address - Street 1:435 BUCKLAND RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06074-3720
Mailing Address - Country:US
Mailing Address - Phone:860-281-1419
Mailing Address - Fax:
Practice Address - Street 1:30 WELLS RD
Practice Address - Street 2:
Practice Address - City:ELLINGTON
Practice Address - State:CT
Practice Address - Zip Code:06029-2112
Practice Address - Country:US
Practice Address - Phone:860-559-8244
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-03
Last Update Date:2016-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002184103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1407206774OtherNPI TYPE 1