Provider Demographics
NPI:1306519921
Name:RICHARDS, IAN (MA, CAS)
Entity type:Individual
Prefix:
First Name:IAN
Middle Name:
Last Name:RICHARDS
Suffix:
Gender:M
Credentials:MA, CAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 DEVEREUX WAY
Mailing Address - Street 2:
Mailing Address - City:RED HOOK
Mailing Address - State:NY
Mailing Address - Zip Code:12571-2268
Mailing Address - Country:US
Mailing Address - Phone:184-575-8189
Mailing Address - Fax:
Practice Address - Street 1:40 DEVEREUX WAY
Practice Address - Street 2:
Practice Address - City:RED HOOK
Practice Address - State:NY
Practice Address - Zip Code:12571-2268
Practice Address - Country:US
Practice Address - Phone:845-758-1899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-29
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool