Fred J Petrilla Jr PHD & Associates PA

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PY0002507 Issued in FL

Legal business name

FRED J PETRILLA JR PHD & ASSOCIATES PA

Practice address

1903 25TH St
Vero Beach, FL 32960-3366

Phone

(772) 562-0777

Fax

(772) 770-3285

NPI assigned

Oct 7, 2011

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Fred J Petrilla Jr., PHD

Title

President

Phone

(772) 562-0777

Specialties & licenses 2

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1317945600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1321488000000",
    "number": "1003190059",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1903 25TH ST",
            "city": "VERO BEACH",
            "state": "FL",
            "postal_code": "329603366",
            "telephone_number": "772-562-0777",
            "fax_number": "772-770-3285"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1903 25TH ST",
            "city": "VERO BEACH",
            "state": "FL",
            "postal_code": "329603366",
            "telephone_number": "772-562-0777",
            "fax_number": "772-770-3285"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FRED J PETRILLA JR PHD & ASSOCIATES PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-10-07",
        "last_updated": "2011-11-17",
        "status": "A",
        "authorized_official_last_name": "PETRILLA",
        "authorized_official_first_name": "FRED",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "772-562-0777",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": "FL",
            "license": "PY0002507",
            "primary": true
        },
        {
            "code": "103TS0200X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist, School",
            "state": "FL",
            "license": "SS33",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mark Frankenberger, PHARM.D.
• Kyle Anthony Franzone
• Christina Marie Fratcher, FNP-BC
• Richard Frates
• Sheree Dominique Ewar Frazier, ARNP
• Gabrielle E Freeman
• Fresenius Medical Care Comprehensive CKD Services Inc (CKD Services of Vero Beach)
• Fresenius Medical Care Vero Beach, LLC (Fresenius Kidney Care Vero Beach)
• Fresh Horizons Alf
• Allen Paul Friedenstab, M.D.

• Clinical Psychologist in Vero Beach, FL
• Providers in Vero Beach, FL by specialty
• Clinical Psychologist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.