Healthcare Provider Details

I. General information

NPI: 1851678148
Provider Name (Legal Business Name): DEENA S. RICHMAN PHD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2011
Last Update Date: 11/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2970 HARTLEY RD STE 201
JACKSONVILLE FL
32257-6245
US

IV. Provider business mailing address

2970 HARTLEY RD STE 201
JACKSONVILLE FL
32257-6245
US

V. Phone/Fax

Practice location:
  • Phone: 904-268-7733
  • Fax: 904-292-1094
Mailing address:
  • Phone: 904-268-7733
  • Fax: 904-292-1094

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: DR. DEENA S RICHMAN
Title or Position: OWNER/PSYCHOLOGIST
Credential: PHD
Phone: 904-268-7733