Organization Name: | FRED J PETRILLA JR PHD & ASSOCIATES PA |
NPI Number: | 1003190059 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | FRED J PETRILLA (PRESIDENT) |
Mailing Address: | 1903 25th St Vero Beach |
State: | FL US |
Postal Code: | 329603366 |
Phone Number: | 7725620777 |
Fax Number: | 7727703285 |
NPI Enumeration Date: | 10/07/2011 |
NPI Last Update Date: | 11/17/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TS0200X |
License Number: | SS33 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | FL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | School |
Taxonomy Definition: |