| Fred J Petrilla Jr Phd & Associates Pa | |
|
1903 25th St Vero Beach FL 32960-3366 | |
| (772) 562-0777 | |
| (772) 770-3285 |
| Full Name | Fred J Petrilla Jr Phd & Associates Pa |
|---|---|
| Speciality | Psychologist - Clinical |
| Location | 1903 25th St, Vero Beach, Florida |
| Authorized Official Name and Position | Fred J Petrilla (PRESIDENT) |
| Authorized Official Contact | 7725620777 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Fred J Petrilla Jr Phd & Associates Pa 1903 25th St Vero Beach FL 32960-3366 Ph: (772) 562-0777 | Fred J Petrilla Jr Phd & Associates Pa 1903 25th St Vero Beach FL 32960-3366 Ph: (772) 562-0777 |
| NPI Number | 1003190059 |
|---|---|
| Provider Enumeration Date | 10/07/2011 |
| Last Update Date | 11/17/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003190059 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | PY0002507 (Florida) | Primary |
| 103TS0200X | Psychologist - School | SS33 (Florida) | Secondary |
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