Provider Demographics
NPI:1104973155
Name:VINNAY, RICHARD J (LISW)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:J
Last Name:VINNAY
Suffix:
Gender:M
Credentials:LISW
Other - Prefix:
Other - First Name:RICK
Other - Middle Name:
Other - Last Name:VINNAY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LISW
Mailing Address - Street 1:PO BOX 961
Mailing Address - Street 2:
Mailing Address - City:CEDAR CREST
Mailing Address - State:NM
Mailing Address - Zip Code:87008-0961
Mailing Address - Country:US
Mailing Address - Phone:505-263-3942
Mailing Address - Fax:505-816-6702
Practice Address - Street 1:6211 SAN MATEO BLVD NE
Practice Address - Street 2:SUITE 170
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-3533
Practice Address - Country:US
Practice Address - Phone:505-263-3942
Practice Address - Fax:505-816-6702
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI43351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical