Provider Demographics
NPI:1487858437
Name:CAULEY, DEAN RUSSELL (PHD)
Entity Type:Individual
Prefix:DR
First Name:DEAN
Middle Name:RUSSELL
Last Name:CAULEY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3270 YUKON DR
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33948-6130
Mailing Address - Country:US
Mailing Address - Phone:941-627-2867
Mailing Address - Fax:
Practice Address - Street 1:2765 TAMIAMI TRL STE C
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-5163
Practice Address - Country:US
Practice Address - Phone:941-661-8895
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH7104101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health