Healthcare Provider Details

I. General information

NPI: 1669447603
Provider Name (Legal Business Name): RICHARD DAVID GARNETT PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 SARATOGA RD PROFESSIONAL BUILDING, SUITE 3
GLENVILLE NY
12302-4108
US

IV. Provider business mailing address

133 SARATOGA RD PROFESSIONAL BUILDING, SUITE 3
GLENVILLE NY
12302-4108
US

V. Phone/Fax

Practice location:
  • Phone: 518-399-4051
  • Fax: 518-399-5447
Mailing address:
  • Phone: 518-399-4051
  • Fax: 518-399-5447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number5312
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: