Provider Demographics
NPI:1316096423
Name:R L WESTBERRY PHD PA
Entity type:Organization
Organization Name:R L WESTBERRY PHD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:L
Authorized Official - Last Name:WESTBERRY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:954-575-8775
Mailing Address - Street 1:3111 N UNIVERSITY DR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-5086
Mailing Address - Country:US
Mailing Address - Phone:954-575-8775
Mailing Address - Fax:
Practice Address - Street 1:3111 N UNIVERSITY DR
Practice Address - Street 2:SUITE 400
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-5086
Practice Address - Country:US
Practice Address - Phone:954-575-8775
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY003524103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK1095Medicare ID - Type Unspecified