Provider Demographics
NPI:1972704849
Name:LINN, RICHARD THOMAS JR (PHD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:THOMAS
Last Name:LINN
Suffix:JR
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2292 EMERY RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH WALES
Mailing Address - State:NY
Mailing Address - Zip Code:14139-9704
Mailing Address - Country:US
Mailing Address - Phone:716-655-0120
Mailing Address - Fax:716-655-0120
Practice Address - Street 1:2292 EMERY RD
Practice Address - Street 2:
Practice Address - City:SOUTH WALES
Practice Address - State:NY
Practice Address - Zip Code:14139-9704
Practice Address - Country:US
Practice Address - Phone:716-655-0120
Practice Address - Fax:716-655-0120
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010603103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist