Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 819 | AL |
Y | 103TC0700X | Clinical Psychologist | 819 | AL |
N | 103G00000X | Clinical Psychologist | 819 | AL |
N | 103TC0700X | Clinical Psychologist | 819 | AL |
NPI | 1003905787 |
---|---|
Provider Name | Richard L Azrin |
First Address | Vestavia, AL 35243-5711 |
Second Address | Vestavia, AL 35243-5711 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2006 |
Last Update Date | 09/05/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
051501026 | BLUE CROSS (01) | AL |
051503120 | FEDERAL BLUE CROSS (01) | AL |
S41988 | (02) | AL |
US DEPART. OF LABOR | 362466400 (01) | AL |