Provider Demographics
NPI:1073055232
Name:STEPHANIE DUTTON PSY.D.,P.A.
Entity Type:Organization
Organization Name:STEPHANIE DUTTON PSY.D.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:MS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:S
Authorized Official - Last Name:DUTTON
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:850-832-6724
Mailing Address - Street 1:11 W 23RD ST BLDG D1
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-4553
Mailing Address - Country:US
Mailing Address - Phone:850-832-6724
Mailing Address - Fax:850-769-2366
Practice Address - Street 1:11 W 23RD ST BLDG D1
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4553
Practice Address - Country:US
Practice Address - Phone:850-832-6724
Practice Address - Fax:850-769-2366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-04
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY8095103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========OtherFLORIDA BLUE