Healthcare Provider Details

I. General information

NPI: 1972260842
Provider Name (Legal Business Name): RICHARD PRITCHARD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/26/2021
Last Update Date: 11/26/2021
Certification Date: 11/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17515 ROCKAWAY BLVD
JAMAICA NY
11434-5503
US

IV. Provider business mailing address

4442 ARTHUR KILL RD
STATEN ISLAND NY
10309-1340
US

V. Phone/Fax

Practice location:
  • Phone: 646-737-6484
  • Fax:
Mailing address:
  • Phone: 718-356-5100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: