Healthcare Provider Details

I. General information

NPI: 1467549717
Provider Name (Legal Business Name): LOUIS D. RICHMOND PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 05/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 BLOOMFIELD AVE. SUITE 201
VERONA NJ
07044-2000
US

IV. Provider business mailing address

450 BLOOMFIELD AVE. SUITE 201
VERONA NJ
07044-2000
US

V. Phone/Fax

Practice location:
  • Phone: 973-857-3113
  • Fax: 973-857-0249
Mailing address:
  • Phone: 973-857-3113
  • Fax: 973-857-0249

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberSI02811
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: