Provider Demographics
NPI:1306890116
Name:GINTY, RICHARD D (LADC, LCSW)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:D
Last Name:GINTY
Suffix:
Gender:M
Credentials:LADC, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 BOSTON POST RD OFC 2
Mailing Address - Street 2:
Mailing Address - City:OLD SAYBROOK
Mailing Address - State:CT
Mailing Address - Zip Code:06475-1557
Mailing Address - Country:US
Mailing Address - Phone:860-661-5397
Mailing Address - Fax:860-339-5010
Practice Address - Street 1:134 BOSTON POST RD OFC 2
Practice Address - Street 2:
Practice Address - City:OLD SAYBROOK
Practice Address - State:CT
Practice Address - Zip Code:06475-1557
Practice Address - Country:US
Practice Address - Phone:860-661-5397
Practice Address - Fax:860-339-5010
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2020-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000624101YA0400X
CT76371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)