Provider Demographics
NPI:1366631608
Name:MICHAEL C RIORDAN PSY D P A
Entity Type:Organization
Organization Name:MICHAEL C RIORDAN PSY D P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED AGENT
Authorized Official - Prefix:MS
Authorized Official - First Name:LUCY
Authorized Official - Middle Name:
Authorized Official - Last Name:RIORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-464-5555
Mailing Address - Street 1:2107 S 10TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34950-5318
Mailing Address - Country:US
Mailing Address - Phone:772-464-5555
Mailing Address - Fax:772-468-8378
Practice Address - Street 1:2107 S 10TH ST
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950-5318
Practice Address - Country:US
Practice Address - Phone:772-464-5555
Practice Address - Fax:772-468-8378
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-23
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensicGroup - Multi-Specialty