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General NPI Number Information
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NPI Number | 1861580821
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Entity Type | Individual
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Provider Name | JEAN-CLAUDE DUTES PHD
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Gender | Male
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Dates
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Enumeration Date | 10/11/2006
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Last Update Date | 10/25/2018
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Provider Practice Location Address
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Address Line | 777 GLADES RD BLDG AZ-79
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City | BOCA RATON
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State | FL
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Zip | 33431-6424
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Country | US
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Telephone | 561-557-1190
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Fax |
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Provider Business Mailing Address
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Address Line | 777 GLADES RD BLDG AZ-79
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City | BOCA RATON
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State | FL
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Zip | 33431-6424
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Country | US
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Telephone | 561-557-1190
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 6301006498
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | LPY19
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License Number State | FL
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