Healthcare Provider Details

I. General information

NPI: 1477568335
Provider Name (Legal Business Name): RICHARD MAYS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2006
Last Update Date: 09/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1219 CTY B
OLD CHATHAM NY
12136
US

IV. Provider business mailing address

8757 108TH ST APT C4
RICHMOND HILL NY
11418-2227
US

V. Phone/Fax

Practice location:
  • Phone: 516-776-6100
  • Fax: 516-766-5471
Mailing address:
  • Phone: 516-236-9415
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number007700
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: