Healthcare Provider Details

I. General information

NPI: 1891092037
Provider Name (Legal Business Name): PHIL RICH ED.D., MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2011
Last Update Date: 02/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 SOUTH STREET STETSON SCHOOL
BARRE MA
01005-0309
US

IV. Provider business mailing address

187 SHUTESBURY RD
AMHERST MA
01002-1264
US

V. Phone/Fax

Practice location:
  • Phone: 978-355-4541
  • Fax: 978-355-2706
Mailing address:
  • Phone: 978-355-4541
  • Fax: 978-355-2706

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number105399
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number007471
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: