Healthcare Provider Details

I. General information

NPI: 1508847260
Provider Name (Legal Business Name): RICHARD ALAN GIANFAGNA PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2005
Last Update Date: 09/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

408 S 14TH ST
RICHMOND IN
47374-6403
US

IV. Provider business mailing address

408 S 14TH ST
RICHMOND IN
47374-6403
US

V. Phone/Fax

Practice location:
  • Phone: 765-935-5344
  • Fax: 765-966-8338
Mailing address:
  • Phone: 765-935-5344
  • Fax: 765-966-8338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number20010442A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: