Provider Demographics
NPI:1942671771
Name:PUROHIT, MUMTA (PSYD)
Entity Type:Individual
Prefix:
First Name:MUMTA
Middle Name:
Last Name:PUROHIT
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4815 TOPPING RD
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-2327
Mailing Address - Country:US
Mailing Address - Phone:240-751-5921
Mailing Address - Fax:
Practice Address - Street 1:9420 KEY WEST AVE
Practice Address - Street 2:STE. 320
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3334
Practice Address - Country:US
Practice Address - Phone:240-751-5921
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-20
Last Update Date:2015-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD05589103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical