Healthcare Provider Details

I. General information

NPI: 1871780726
Provider Name (Legal Business Name): RICHARD NICASTRO PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2007
Last Update Date: 05/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1180 COMMERCE DR
LAS CRUCES NM
88011-8210
US

IV. Provider business mailing address

1180 COMMERCE DR PO BOX 13663
LAS CRUCES NM
88011-8210
US

V. Phone/Fax

Practice location:
  • Phone: 575-915-2601
  • Fax:
Mailing address:
  • Phone: 575-915-2601
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1076
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: