Provider Demographics
NPI:1265636567
Name:BROTTMAN, MIKITA (PHD, CT)
Entity type:Individual
Prefix:DR
First Name:MIKITA
Middle Name:
Last Name:BROTTMAN
Suffix:
Gender:F
Credentials:PHD, CT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 E CHASE ST
Mailing Address - Street 2:BELVEDERE HOTEL, SUITE #501
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21202-2526
Mailing Address - Country:US
Mailing Address - Phone:410-385-0123
Mailing Address - Fax:410-385-0123
Practice Address - Street 1:1 E CHASE ST
Practice Address - Street 2:BELVEDERE HOTEL, SUITE #501
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-2526
Practice Address - Country:US
Practice Address - Phone:410-385-0123
Practice Address - Fax:410-385-0123
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst