Provider Demographics
NPI:1306909627
Name:DEITCHMAN, PAUL S (PHD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:S
Last Name:DEITCHMAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:916 N GADSDEN ST
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32303-6316
Mailing Address - Country:US
Mailing Address - Phone:850-878-3571
Mailing Address - Fax:850-878-1547
Practice Address - Street 1:916 N GADSDEN ST
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32303-6316
Practice Address - Country:US
Practice Address - Phone:850-878-3571
Practice Address - Fax:850-878-1547
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY2143103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical