Healthcare Provider Details

I. General information

NPI: 1053678185
Provider Name (Legal Business Name): RICHARD BOURDON ESCODA PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2012
Last Update Date: 01/28/2026
Certification Date: 01/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

816 CHERRY ELM DR
ST AUGUSTINE FL
32092-0137
US

IV. Provider business mailing address

816 CHERRY ELM DR
ST AUGUSTINE FL
32092-0137
US

V. Phone/Fax

Practice location:
  • Phone: 904-629-8455
  • Fax:
Mailing address:
  • Phone: 904-629-5106
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2537
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY11492
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: