Provider Demographics
NPI:1871925537
Name:MCCUTCHAN, JUETA
Entity type:Individual
Prefix:
First Name:JUETA
Middle Name:
Last Name:MCCUTCHAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1078
Mailing Address - Street 2:
Mailing Address - City:PAGO PAGO
Mailing Address - State:AS
Mailing Address - Zip Code:96799-1078
Mailing Address - Country:US
Mailing Address - Phone:684-699-9185
Mailing Address - Fax:
Practice Address - Street 1:1078 MALAEIMI STREET
Practice Address - Street 2:
Practice Address - City:PAGO PAGO
Practice Address - State:AMERICAN SAMOA
Practice Address - Zip Code:96799
Practice Address - Country:UM
Practice Address - Phone:684-699-9185
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-05
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AS4083-C103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical