Provider Demographics
NPI:1154520393
Name:TODD, RICHARD LEROY (PHD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:LEROY
Last Name:TODD
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34465 BOOKHAMMER LANDING RD
Mailing Address - Street 2:
Mailing Address - City:LEWES
Mailing Address - State:DE
Mailing Address - Zip Code:19958-5746
Mailing Address - Country:US
Mailing Address - Phone:302-853-0559
Mailing Address - Fax:302-231-2086
Practice Address - Street 1:28312 LEWES GEORGETOWN HWY
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:DE
Practice Address - Zip Code:19968-3115
Practice Address - Country:US
Practice Address - Phone:302-853-0559
Practice Address - Fax:302-231-2086
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-17
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEB1-0000769103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
R74412Medicare UPIN
DE492226Medicare PIN