| Doctor Name: | DEWEY SCOTT MAYBERRY |
| NPI Number: | 1063686699 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.A. LMHC |
| License Number: | MH7715 |
| Business Practice Address: | 4626 Lori Ln Pace, FL - 325711560 |
| Business Phone Number: | 8502663025 |
| Business Fax Number: | 8509449676 |
| Mailing Address: | 4626 Lori Ln, PACE |
| State: | FL |
| Postal Code: | 325711560 |
| Phone Number: | 8502663025 |
| Fax Number: | 8509449676 |
| NPI Enumeration Date: | 04/15/2008 |
| NPI Last Update Date: | 04/15/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | MH7715 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |