Organization
GERARD E. BOUTIN PHD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GERARD E. BOUTIN PHD (PRESIDENT)
(727) 452-5083
Entity
Organization
Contact information
Practice address
13787 BELCHER RD S, 140, LARGO, FL 33771-4065
(727) 452-5083
Mailing address
13787 BELCHER RD S, 140, LARGO, FL 33771-4065
(727) 452-5083
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
PY0002716
FL
103TC0700X
Clinical Psychologist
Primary
PY0002716
FL
103TC2200X
Clinical Child & Adolescent Psychologist
PY0002716
FL
Other
Enumeration date
01/23/2013
Last updated
01/23/2013
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