Organization
FRED J PETRILLA JR PHD & ASSOCIATES PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
FRED J PETRILLA JR. PHD (PRESIDENT)
(772) 562-0777
Entity
Organization
Contact information
Practice address
1903 25TH ST, VERO BEACH, FL 32960-3366
(772) 562-0777
(772) 770-3285
Mailing address
1903 25TH ST, VERO BEACH, FL 32960-3366
(772) 562-0777
(772) 770-3285
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PY0002507
FL
103TS0200X
School Psychologist
SS33
FL
Other
Enumeration date
10/07/2011
Last updated
11/17/2011
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