Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 010822 | NY |
NPI | 1093311672 |
---|---|
Provider Name | Ian Richmond |
First Address | Teaneck, NJ 07666-3653 |
Second Address | Teaneck, NJ 07666-3653 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/12/2020 |
Last Update Date | 30/08/2021 |