Provider Demographics
NPI:1144467036
Name:DEVITO, CRYSTAL KAY (PHD)
Entity type:Individual
Prefix:DR
First Name:CRYSTAL
Middle Name:KAY
Last Name:DEVITO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 ALLEGHENY AVE
Mailing Address - Street 2:SUITE 1208
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-3909
Mailing Address - Country:US
Mailing Address - Phone:443-799-6477
Mailing Address - Fax:410-583-5553
Practice Address - Street 1:28 ALLEGHENY AVE
Practice Address - Street 2:SUITE 1208
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-3909
Practice Address - Country:US
Practice Address - Phone:443-799-6477
Practice Address - Fax:410-583-5553
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-14
Last Update Date:2009-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03920103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent