Provider Demographics
NPI:1447656749
Name:RICHARDSON, EDRICA D (PHD)
Entity type:Individual
Prefix:DR
First Name:EDRICA D
Middle Name:
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7027 W BROWARD BLVD
Mailing Address - Street 2:#169
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317-2208
Mailing Address - Country:US
Mailing Address - Phone:813-464-4820
Mailing Address - Fax:
Practice Address - Street 1:7027 W BROWARD BLVD
Practice Address - Street 2:#169
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-2208
Practice Address - Country:US
Practice Address - Phone:813-464-4820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-13
Last Update Date:2014-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT2813106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist