Provider Demographics
NPI:1851678148
Name:DEENA S. RICHMAN PHD PA
Entity Type:Organization
Organization Name:DEENA S. RICHMAN PHD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DEENA
Authorized Official - Middle Name:S
Authorized Official - Last Name:RICHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:904-268-7733
Mailing Address - Street 1:2970 HARTLEY RD
Mailing Address - Street 2:STE 201
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32257-6245
Mailing Address - Country:US
Mailing Address - Phone:904-268-7733
Mailing Address - Fax:904-292-1094
Practice Address - Street 1:2970 HARTLEY RD
Practice Address - Street 2:STE 201
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257-6245
Practice Address - Country:US
Practice Address - Phone:904-268-7733
Practice Address - Fax:904-292-1094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-15
Last Update Date:2013-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL73653Medicare PIN