Provider Demographics
NPI:1306865894
Name:WESTBERRY, RICHARD LEE (PHD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:LEE
Last Name:WESTBERRY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3111 N UNIVERSITY DR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-5086
Mailing Address - Country:US
Mailing Address - Phone:954-575-8775
Mailing Address - Fax:
Practice Address - Street 1:3111 N UNIVERSITY DR
Practice Address - Street 2:SUITE 400
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-5086
Practice Address - Country:US
Practice Address - Phone:954-575-8775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY-00003524103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL75802OtherBLUE CROSS & BLUE SHIELD
FL34687OtherBLUE CROSS & BLUE SHIELD
FL34687OtherBLUE CROSS & BLUE SHIELD