Provider Demographics
NPI:1679972806
Name:HOOTS, FREDERICK (BCBA)
Entity type:Individual
Prefix:MR
First Name:FREDERICK
Middle Name:
Last Name:HOOTS
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 PRIMROSE CT
Mailing Address - Street 2:
Mailing Address - City:PARKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21234-3366
Mailing Address - Country:US
Mailing Address - Phone:410-808-6561
Mailing Address - Fax:
Practice Address - Street 1:25 PRIMROSE CT
Practice Address - Street 2:
Practice Address - City:PARKVILLE
Practice Address - State:MD
Practice Address - Zip Code:21234-3366
Practice Address - Country:US
Practice Address - Phone:410-808-6561
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-13
Last Update Date:2014-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1-09-6427103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst