Provider Demographics
NPI:1851863294
Name:GORMAN, RICHARD MICHAEL III (LPC)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:MICHAEL
Last Name:GORMAN
Suffix:III
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 COMMODORE HULL DR
Mailing Address - Street 2:
Mailing Address - City:DERBY
Mailing Address - State:CT
Mailing Address - Zip Code:06418-2255
Mailing Address - Country:US
Mailing Address - Phone:860-830-7967
Mailing Address - Fax:
Practice Address - Street 1:18 COMMODORE HULL DR
Practice Address - Street 2:
Practice Address - City:DERBY
Practice Address - State:CT
Practice Address - Zip Code:06418-2255
Practice Address - Country:US
Practice Address - Phone:860-830-7967
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-26
Last Update Date:2018-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003630101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional