Individual
MR. MILES ROBERT WALTUCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSY.M.
Contact information
Practice address
200 E NORTH AVE, BALTIMORE, MD 21202-5984
(609) 273-6444
Mailing address
200 E NORTH AVE, BALTIMORE, MD 21202-5984
(609) 273-6444
Taxonomy
Speciality
Code
Description
License number
State
103TS0200X
School Psychologist
Primary
—
—
Other
Enumeration date
11/25/2024
Last updated
11/25/2024
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