Provider Demographics
NPI:1851696389
Name:REDDEN, VINCENT WILLIAM JR
Entity Type:Individual
Prefix:MR
First Name:VINCENT
Middle Name:WILLIAM
Last Name:REDDEN
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 CARTAGESA
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-3436
Mailing Address - Country:US
Mailing Address - Phone:772-985-9002
Mailing Address - Fax:772-484-0087
Practice Address - Street 1:121 N 2ND ST
Practice Address - Street 2:SUITE 301
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950-4435
Practice Address - Country:US
Practice Address - Phone:772-595-3773
Practice Address - Fax:772-484-0087
Is Sole Proprietor?:No
Enumeration Date:2011-01-13
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL03-802008347104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker