MEDICARE: MICHAEL C RIORDAN PSY D P A

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	103G00000X	Clinical Neuropsychologist
2	103TF0200X	Forensic Psychologist
3	103TC0700X	Clinical Psychologist

General Provider Information

NPI Number	:	1366631608
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHAEL C RIORDAN PSY D P A

Provider Business Mailing Address
First Line	:	2107 S 10TH ST
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34950-5318
Country	:	US
Telephone Number	:	772-464-5555
Fax Number	:	772-468-8378

Provider Business Practice Location Address
First Line	:	2107 S 10TH ST
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34950-5318
Country	:	US
Telephone Number	:	772-464-5555
Fax Number	:	772-468-8378

Authorized Official
Title or Position	:	REGISTERED AGENT
Name	:	MS. LUCY RIORDAN
Credential	:
Telephone Number	:	772-464-5555

Provider Enumeration Date	:	10/23/2007
Last Update Date	:	05/29/2008

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