Provider Demographics
NPI:1952530057
Name:SUTTON, MONICA J (PHD)
Entity type:Individual
Prefix:DR
First Name:MONICA
Middle Name:J
Last Name:SUTTON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2500 N STATE ST
Mailing Address - Street 2:DEPARTMENT OF PEDIATRICS
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4500
Mailing Address - Country:US
Mailing Address - Phone:601-815-7358
Mailing Address - Fax:601-984-2975
Practice Address - Street 1:2500 N STATE ST
Practice Address - Street 2:DEPARTMENT OF PEDIATRICS
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4500
Practice Address - Country:US
Practice Address - Phone:601-815-7358
Practice Address - Fax:601-984-2975
Is Sole Proprietor?:No
Enumeration Date:2009-07-09
Last Update Date:2015-06-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MS48842103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS302I688025Medicare PIN
MS302I689143Medicare PIN