Active NPI
Richard Walter Fedora, LMHC
- Mental Health Counselor
- Tampa, FL
National Provider Identifier
1194821074
On this page
OIG exclusion record
The HHS Office of Inspector General’s List of Excluded Individuals/Entities (LEIE) contains a record with this NPI:
- Section 1128b(4) exclusion effective Apr 20, 2015.
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- MH 2794
- Practice address
- 4726 N Habana Ave
Suite 204
Tampa, FL 33614-7144 - Phone
- (813) 872-7582
- Fax
- (813) 873-9591
- NPI assigned
- Sep 16, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | MH 2794 | FL | Primary |
Addresses
Primary practice location
4726 N Habana Ave
Suite 204
Tampa, FL 33614-7144
Mailing address
4726 N Habana Ave
Suite 204
Tampa, FL 33614-7144
Phone (813) 872-7582
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- HHS exclusion list flag
- Flagged The directory lists this NPI on an HHS exclusion list.
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MH 2794 | FL | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158364800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1194821074",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4726 N HABANA AVE",
"address_2": "SUITE 204",
"city": "TAMPA",
"state": "FL",
"postal_code": "336147144",
"telephone_number": "813-872-7582",
"fax_number": "813-873-9591"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4726 N HABANA AVE",
"address_2": "SUITE 204",
"city": "TAMPA",
"state": "FL",
"postal_code": "336147144",
"telephone_number": "813-872-7582",
"fax_number": "813-873-9591"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FEDORA",
"first_name": "RICHARD",
"middle_name": "WALTER",
"credential": "LMHC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-16",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "FL",
"license": "MH 2794",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tampa, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.