Provider Demographics
NPI:1710152780
Name:RHONDA PERDUE PHD PA
Entity Type:Organization
Organization Name:RHONDA PERDUE PHD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KARL
Authorized Official - Middle Name:
Authorized Official - Last Name:PERDUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-271-4394
Mailing Address - Street 1:10111 W FOREST HILL BLVD
Mailing Address - Street 2:SUITE 369
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-6108
Mailing Address - Country:US
Mailing Address - Phone:561-784-7767
Mailing Address - Fax:
Practice Address - Street 1:10111 W FOREST HILL BLVD
Practice Address - Street 2:SUITE 369
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-6108
Practice Address - Country:US
Practice Address - Phone:561-784-7767
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RHONDA PERDUE PHD PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-29
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY5257103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK8783OtherMEDICARE GROUP
FLK8783OtherMEDICARE GROUP