Provider Demographics
NPI:1053678185
Name:BOURDON ESCODA, RICHARD (PSYD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:
Last Name:BOURDON ESCODA
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6650 CORPORATE CENTER PKWY APT 510
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-8733
Mailing Address - Country:US
Mailing Address - Phone:787-306-8471
Mailing Address - Fax:
Practice Address - Street 1:6650 CORPORATE CENTER PKWY APT 510
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-8733
Practice Address - Country:US
Practice Address - Phone:787-306-8471
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-13
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2537103TC0700X
FLPY11492103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical