Healthcare Provider Details

I. General information

NPI: 1720067754
Provider Name (Legal Business Name): GREGORY RICHTER PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2006
Last Update Date: 01/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RAF LAKENHEATH 48 MDG/SGHC UNIT 5115
APO AE
09461-5115
US

IV. Provider business mailing address

RAF LAKENHEATH 48 MDG/SGHC UNIT 5115
APO AE
09461-5115
US

V. Phone/Fax

Practice location:
  • Phone: 011441638523308
  • Fax:
Mailing address:
  • Phone: 011441638523308
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0810001151
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: