Provider Demographics
NPI:1336315399
Name:RICHADSON, RALPH (PHD,LP)
Entity Type:Individual
Prefix:DR
First Name:RALPH
Middle Name:
Last Name:RICHADSON
Suffix:
Gender:M
Credentials:PHD,LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1175 NE 125TH ST
Mailing Address - Street 2:SUITE 410
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33161-5015
Mailing Address - Country:US
Mailing Address - Phone:305-335-1800
Mailing Address - Fax:305-893-3323
Practice Address - Street 1:1175 NE 125TH ST
Practice Address - Street 2:SUITE 410
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33161-5015
Practice Address - Country:US
Practice Address - Phone:305-335-1800
Practice Address - Fax:305-893-3323
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-30
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY6671103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic