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General NPI Number Information
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NPI Number | 1003143298
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Entity Type | Organization
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Legal Business Name | BRIAN RICHARDSON, PSYD, PC
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Dates
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Enumeration Date | 11/09/2009
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Last Update Date | 10/28/2010
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Provider Practice Location Address
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Address Line | 3233 N ARLINGTON HEIGHTS RD SUITE 301
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City | ARLINGTON HEIGHTS
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State | IL
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Zip | 60004-1557
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Country | US
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Telephone | 847-650-0307
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Fax | 847-222-9769
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Provider Business Mailing Address
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Address Line | 3233 N ARLINGTON HEIGHTS RD SUITE 301
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City | ARLINGTON HEIGHTS
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State | IL
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Zip | 60004-1557
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Country | US
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Telephone | 847-650-0307
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Fax | 847-222-9769
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Authorized Official
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Title or Position | OWNER/ PSYCHOLOGIST
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Name | DR. BRIAN J RICHARDSON
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Credential | PSYD
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Telephone | 847-650-0307
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 71004102
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License Number State | IL
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