Provider Demographics
NPI:1235127234
Name:LUMPKIN, PEYTON WHITE (PHD)
Entity Type:Individual
Prefix:DR
First Name:PEYTON
Middle Name:WHITE
Last Name:LUMPKIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6258 SW 99TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156-3345
Mailing Address - Country:US
Mailing Address - Phone:305-322-2366
Mailing Address - Fax:305-444-5366
Practice Address - Street 1:1450 MADRUGA AVE
Practice Address - Street 2:SUITE 304
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33146-3148
Practice Address - Country:US
Practice Address - Phone:305-322-2366
Practice Address - Fax:305-444-5366
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY6087103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL54518OtherBLUE CROSS BLUE SHIELD
FL54518Medicare ID - Type Unspecified