MEDICARE: JEAN-CLAUDE DUTES PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	6301006498	MI
2	103T00000X	Psychologist	LPY19	FL

General Provider Information

NPI Number	:	1861580821
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEAN-CLAUDE DUTES PHD

Provider Business Mailing Address
First Line	:	777 GLADES RD BLDG AZ-79
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33431-6424
Country	:	US
Telephone Number	:	561-557-1190
Fax Number	:

Provider Business Practice Location Address
First Line	:	777 GLADES RD BLDG AZ-79
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33431-6424
Country	:	US
Telephone Number	:	561-557-1190
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/11/2006
Last Update Date	:	10/25/2018

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