Provider Demographics
NPI:1851658272
Name:PEDRAZA, RICHARD JOSEPH JR
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:JOSEPH
Last Name:PEDRAZA
Suffix:JR
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:RICK
Other - Middle Name:JOSEPH
Other - Last Name:PEDRAZA
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:310 RACHELLE AVE
Mailing Address - Street 2:# 737
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-7968
Mailing Address - Country:US
Mailing Address - Phone:407-506-7785
Mailing Address - Fax:407-894-6010
Practice Address - Street 1:2479 ALOMA AVE
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-2541
Practice Address - Country:US
Practice Address - Phone:407-657-6692
Practice Address - Fax:407-894-6010
Is Sole Proprietor?:No
Enumeration Date:2012-04-23
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health