Healthcare Provider Details

I. General information

NPI: 1457409765
Provider Name (Legal Business Name): RICHARD R BEBOUT PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 05/15/2025
Certification Date: 05/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 DELAWARE AVE SW
WASHINGTON DC
20024-4208
US

IV. Provider business mailing address

1100 NEW JERSEY AVE SE STE 500
WASHINGTON DC
20003-3326
US

V. Phone/Fax

Practice location:
  • Phone: 240-353-5806
  • Fax:
Mailing address:
  • Phone: 240-353-5806
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY1000100
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number02444
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: