Provider Demographics
NPI:1033458641
Name:YEICH, RICHELE GAYLE
Entity Type:Individual
Prefix:MS
First Name:RICHELE
Middle Name:GAYLE
Last Name:YEICH
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:RICHELE
Other - Middle Name:GAYLE
Other - Last Name:ZVORSKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:703 QUAIL HOLLOW WAY
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-1756
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1320 CULVER DR
Practice Address - Street 2:STE 3
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32907
Practice Address - Country:US
Practice Address - Phone:570-449-9794
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-04
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA$$$$$$$$$Medicaid