Provider Demographics
NPI:1427017508
Name:PINTO, DEBORAH RENEE (PHD)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:RENEE
Last Name:PINTO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:12859 WINGED ELM DR N
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32246-1154
Mailing Address - Country:US
Mailing Address - Phone:904-992-8771
Mailing Address - Fax:904-745-3131
Practice Address - Street 1:943 CESERY BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32211-5635
Practice Address - Country:US
Practice Address - Phone:904-745-3111
Practice Address - Fax:904-745-3131
Is Sole Proprietor?:No
Enumeration Date:2006-03-19
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY0005560103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL54102ZMedicare PIN