Provider Demographics
NPI:1770149775
Name:DUTTON, ERIC (MSW)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:DUTTON
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8413 SW 54TH LN
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-4318
Mailing Address - Country:US
Mailing Address - Phone:620-704-4642
Mailing Address - Fax:
Practice Address - Street 1:7106 NW 11TH PL STE B
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-3140
Practice Address - Country:US
Practice Address - Phone:352-660-4142
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-15
Last Update Date:2023-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSWI133411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical