Gerard E. Boutin Phd PA
Psychologist, Clinical in Largo, FL. Organization (NPI-2).
NPI number1124366364
StatusActive
Last updated in NPPESJan 23, 2013
Details
- NPI
- 1124366364
- Entity type
- Organization (NPI-2)
- Legal business name
- Gerard E. Boutin Phd PA
- Organization subpart
- No
- Enumeration date
- Jan 23, 2013
- Last updated
- Jan 23, 2013
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 103TC0700X | Psychologist, Clinical | PY0002716 | FL | Yes |
| 103G00000X | Clinical Neuropsychologist | PY0002716 | FL | |
| 103TC2200X | Psychologist, Clinical Child & Adolescent | PY0002716 | FL |
Practice location
13787 Belcher Rd S140
Largo, FL 33771-4065
Phone 727-452-5083
Mailing address
13787 Belcher Rd S140
Largo, FL 33771-4065
Phone 727-452-5083
Authorized official
Gerard E. Boutin
President
7274525083
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