Provider Demographics
NPI:1902979743
Name:DILLON, JESSE LEE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JESSE
Middle Name:LEE
Last Name:DILLON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:890 SOUTH PALAFOX STREET
Mailing Address - Street 2:SUITE 300
Mailing Address - City:PENSACOLOA
Mailing Address - State:FL
Mailing Address - Zip Code:32502
Mailing Address - Country:US
Mailing Address - Phone:850-433-1656
Mailing Address - Fax:850-433-1996
Practice Address - Street 1:890 SOUTH PALAFOX STREET
Practice Address - Street 2:SUITE 300
Practice Address - City:PENSACOLOA
Practice Address - State:FL
Practice Address - Zip Code:32502
Practice Address - Country:US
Practice Address - Phone:850-433-1656
Practice Address - Fax:850-433-1996
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016706103T00000X
FLPY7678103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist