Healthcare Provider Details

I. General information

NPI: 1710101290
Provider Name (Legal Business Name): DEBORAH RICH PH.D., LP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 06/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1619 DAYTON AVE STE 201
SAINT PAUL MN
55104
US

IV. Provider business mailing address

1619 DAYTON AVE STE 201
SAINT PAUL MN
55104-6276
US

V. Phone/Fax

Practice location:
  • Phone: 651-645-5504
  • Fax: 651-404-2512
Mailing address:
  • Phone: 651-645-5504
  • Fax: 651-404-2512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1281
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: