Provider Demographics
NPI:1063686699
Name:MAYBERRY, DEWEY SCOTT (MA LMHC)
Entity Type:Individual
Prefix:
First Name:DEWEY
Middle Name:SCOTT
Last Name:MAYBERRY
Suffix:
Gender:M
Credentials:MA LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4626 LORI LN
Mailing Address - Street 2:
Mailing Address - City:PACE
Mailing Address - State:FL
Mailing Address - Zip Code:32571-1560
Mailing Address - Country:US
Mailing Address - Phone:850-266-3025
Mailing Address - Fax:850-944-9676
Practice Address - Street 1:4626 LORI LN
Practice Address - Street 2:
Practice Address - City:PACE
Practice Address - State:FL
Practice Address - Zip Code:32571-1560
Practice Address - Country:US
Practice Address - Phone:850-266-3025
Practice Address - Fax:850-944-9676
Is Sole Proprietor?:No
Enumeration Date:2008-04-15
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH7715101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL289431Medicare PIN