Healthcare Provider Details

I. General information

NPI: 1407819618
Provider Name (Legal Business Name): RICHARD M VINCENT MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

WIESBADEN HEALTH CLINIC
APO AE HESSEN
09096
DE

IV. Provider business mailing address

CMR 467 BOX 851
APO AE HESSEN
09096
DE

V. Phone/Fax

Practice location:
  • Phone: 014906117055999
  • Fax: 014906117055984
Mailing address:
  • Phone: 014906117055999
  • Fax: 014906117055984

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberDP00816777
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: