Provider Demographics
NPI:1417178450
Name:RICHMOND, FREDRIC (PHD)
Entity Type:Individual
Prefix:
First Name:FREDRIC
Middle Name:
Last Name:RICHMOND
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 1:18971 ANTIOCH DRIVE
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92603
Mailing Address - Country:US
Mailing Address - Phone:949-679-9749
Mailing Address - Fax:
Practice Address - Street 1:18971 ANTIOCH DRIVE
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92603
Practice Address - Country:US
Practice Address - Phone:949-679-9749
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS-005061-L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist