Basic Information
| Provider Information | |||||||||
| NPI: | 1073055232 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | STEPHANIE DUTTON PSY.D.,P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11 W 23RD ST BLDG D1 | ||||||||
| Address2: | |||||||||
| City: | PANAMA CITY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 324054553 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8508326724 | ||||||||
| FaxNumber: | 8507692366 | ||||||||
| Practice Location | |||||||||
| Address1: | 11 W 23RD ST BLDG D1 | ||||||||
| Address2: | |||||||||
| City: | PANAMA CITY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 324054553 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8508326724 | ||||||||
| FaxNumber: | 8507692366 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/04/2016 | ||||||||
| LastUpdateDate: | 06/20/2018 | ||||||||
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| AuthorizedOfficialLastName: | DUTTON | ||||||||
| AuthorizedOfficialFirstName: | STEPHANIE | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | CLINICAL PSYCHOLOGIST | ||||||||
| AuthorizedOfficialTelephone: | 8508326724 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | PSYD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | PY8095 | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.