Provider Demographics
NPI:1932288172
Name:SIMANTON, DEXTER (PSYD)
Entity Type:Individual
Prefix:
First Name:DEXTER
Middle Name:
Last Name:SIMANTON
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 LOOKOUT PL # 202
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-4492
Mailing Address - Country:US
Mailing Address - Phone:407-647-1781
Mailing Address - Fax:407-647-4628
Practice Address - Street 1:260 LOOKOUT PL # 202
Practice Address - Street 2:
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-4492
Practice Address - Country:US
Practice Address - Phone:407-647-1781
Practice Address - Fax:407-647-4628
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY0004951101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health