Provider Demographics
NPI:1548250988
Name:RICHMAN, DEENA S (PHD)
Entity type:Individual
Prefix:
First Name:DEENA
Middle Name:S
Last Name:RICHMAN
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 1:2970 HARTLEY RD
Mailing Address - Street 2:STE 201
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32257-8227
Mailing Address - Country:US
Mailing Address - Phone:904-268-7733
Mailing Address - Fax:904-292-1094
Practice Address - Street 1:2970 HARTLEY RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257-8227
Practice Address - Country:US
Practice Address - Phone:904-268-7733
Practice Address - Fax:904-292-1094
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY4350103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
73653Medicare ID - Type Unspecified