Provider Demographics
NPI:1497398358
Name:DR BEVERLY PEDROCHE INC
Entity Type:Organization
Organization Name:DR BEVERLY PEDROCHE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PVST
Authorized Official - Prefix:DR
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:JOY
Authorized Official - Last Name:PEDROCHE
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:954-816-0085
Mailing Address - Street 1:5204 WHEATLEY COURT
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33436
Mailing Address - Country:US
Mailing Address - Phone:954-816-0085
Mailing Address - Fax:
Practice Address - Street 1:4400 N, FEDERAL HIGHWAY
Practice Address - Street 2:SUITE 210-48
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431
Practice Address - Country:US
Practice Address - Phone:561-805-3600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-23
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty