Provider Demographics
NPI:1659420396
Name:DEITCHMAN, GEORGE (PHD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:
Last Name:DEITCHMAN
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 1:332 6TH ST
Mailing Address - Street 2:
Mailing Address - City:ATLANTIC BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32233-5348
Mailing Address - Country:US
Mailing Address - Phone:904-568-8927
Mailing Address - Fax:904-241-0883
Practice Address - Street 1:710 3RD ST N
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-7149
Practice Address - Country:US
Practice Address - Phone:904-568-8927
Practice Address - Fax:904-241-0883
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT 1169106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist