Healthcare Provider Details

I. General information

NPI: 1427668508
Provider Name (Legal Business Name): RICHARD DAVID LLANTON LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2020
Last Update Date: 08/04/2020
Certification Date: 08/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 BI COUNTY BLVD STE 450
FARMINGDALE NY
11735-3995
US

IV. Provider business mailing address

2714 AVENUE D APT 2B
BROOKLYN NY
11226-7851
US

V. Phone/Fax

Practice location:
  • Phone: 718-264-1640
  • Fax:
Mailing address:
  • Phone: 954-798-3230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number010570-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: