Provider Demographics
NPI:1356552442
Name:HEWITT, DARYL (MA, BSL)
Entity type:Individual
Prefix:
First Name:DARYL
Middle Name:
Last Name:HEWITT
Suffix:
Gender:M
Credentials:MA, BSL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 HIGHLAND DR
Mailing Address - Street 2:PO BOX 597
Mailing Address - City:MOUNTVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17554-1232
Mailing Address - Country:US
Mailing Address - Phone:717-285-7121
Mailing Address - Fax:717-285-5302
Practice Address - Street 1:2330 VARTAN WAY
Practice Address - Street 2:STE 204
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17110-9763
Practice Address - Country:US
Practice Address - Phone:717-920-9434
Practice Address - Fax:717-920-9197
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X
PABH002056103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist