Healthcare Provider Details

I. General information

NPI: 1992922801
Provider Name (Legal Business Name): CHANELLE RICHARDS PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2007
Last Update Date: 02/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 TERMAKAY DR
NEW CITY NY
10956-6434
US

IV. Provider business mailing address

8 TERMAKAY DR
NEW CITY NY
10956-6434
US

V. Phone/Fax

Practice location:
  • Phone: 718-541-6453
  • Fax:
Mailing address:
  • Phone: 718-541-6453
  • Fax: 888-959-2301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number017079
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number017079
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number017079
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number017079
License Number StateNY
# 5
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number017079
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: