Healthcare Provider Details

I. General information

NPI: 1225553613
Provider Name (Legal Business Name): DEBORAH KUTNER PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2076 SEAWIND CT
INDIALANTIC FL
32903-2551
US

IV. Provider business mailing address

2076 SEAWIND CT
INDIALANTIC FL
32903-2551
US

V. Phone/Fax

Practice location:
  • Phone: 321-795-9119
  • Fax:
Mailing address:
  • Phone: 321-795-9119
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number10462
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: