Provider Demographics
NPI:1689692766
Name:RICHARDS, TERRY DAVID II (PHD)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:DAVID
Last Name:RICHARDS
Suffix:II
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1717 N BAYSHORE DR
Mailing Address - Street 2:3456
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33132-1180
Mailing Address - Country:US
Mailing Address - Phone:305-577-1013
Mailing Address - Fax:305-577-1019
Practice Address - Street 1:1717 N BAYSHORE DR
Practice Address - Street 2:3456
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33132-1180
Practice Address - Country:US
Practice Address - Phone:305-577-1013
Practice Address - Fax:305-577-1019
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPY4934103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV27741Medicare ID - Type Unspecified