Provider Demographics
NPI:1508140658
Name:PEDROCHE, BEVERLY JOY (PSYD)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:JOY
Last Name:PEDROCHE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4800 N FEDERAL HWY
Mailing Address - Street 2:SUITE E-102
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-5188
Mailing Address - Country:US
Mailing Address - Phone:561-368-8430
Mailing Address - Fax:561-362-5575
Practice Address - Street 1:4800 N FEDERAL HWY
Practice Address - Street 2:SUITE E-102
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-5188
Practice Address - Country:US
Practice Address - Phone:561-368-8430
Practice Address - Fax:561-362-5575
Is Sole Proprietor?:No
Enumeration Date:2011-10-07
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY8087103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical