Provider Demographics
NPI:1700116274
Name:RICHARD T ELMORE JR PHD PA
Entity Type:Organization
Organization Name:RICHARD T ELMORE JR PHD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:TURNER
Authorized Official - Last Name:ELMORE
Authorized Official - Suffix:JR
Authorized Official - Credentials:PHD
Authorized Official - Phone:321-728-9620
Mailing Address - Street 1:100 RIALTO PL
Mailing Address - Street 2:SUITE 754
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-3055
Mailing Address - Country:US
Mailing Address - Phone:321-728-9620
Mailing Address - Fax:321-951-1928
Practice Address - Street 1:100 RIALTO PL
Practice Address - Street 2:SUITE 754
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-3055
Practice Address - Country:US
Practice Address - Phone:321-728-9620
Practice Address - Fax:321-951-1928
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-06
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY3228103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty