Provider Demographics
NPI:1124698766
Name:RICHARD, JONATHAN D (CNP-PSYCHIATRIC)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:D
Last Name:RICHARD
Suffix:
Gender:
Credentials:CNP-PSYCHIATRIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 TECHNOLOGY DR STE 102
Mailing Address - Street 2:
Mailing Address - City:NORTH CHELMSFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01863-2441
Mailing Address - Country:US
Mailing Address - Phone:978-677-6354
Mailing Address - Fax:
Practice Address - Street 1:7 TECHNOLOGY DR STE 102
Practice Address - Street 2:
Practice Address - City:NORTH CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01863-2441
Practice Address - Country:US
Practice Address - Phone:978-677-6354
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-27
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2347075363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health