Provider Demographics
NPI:1609482538
Name:QUATTLEBAUM, GRETCHEN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:GRETCHEN
Middle Name:
Last Name:QUATTLEBAUM
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 JUPITER LAKES BLVD STE 302A
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-7100
Mailing Address - Country:US
Mailing Address - Phone:561-429-2397
Mailing Address - Fax:
Practice Address - Street 1:345 JUPITER LAKES BLVD STE 302A
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-7100
Practice Address - Country:US
Practice Address - Phone:561-429-2397
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-16
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY10846103T00000X, 103TC0700X
IL071.010341103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist