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General NPI Number Information
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NPI Number | 1316216195
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Entity Type | Organization
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Legal Business Name | RICHARD A GIANFAGNA, PH,D., P.C.
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Dates
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Enumeration Date | 12/22/2011
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Last Update Date | 06/03/2012
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Provider Practice Location Address
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Address Line | 408 S 14TH ST
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City | RICHMOND
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State | IN
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Zip | 47374-6403
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Country | US
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Telephone | 765-935-5344
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Fax |
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Provider Business Mailing Address
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Address Line | 408 S 14TH ST
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City | RICHMOND
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State | IN
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Zip | 47374-6403
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Country | US
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Telephone | 765-935-5344
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | RICHARD A GIANFAGNA
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Credential | PH.D.
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Telephone | 765-935-5344
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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 |
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License Number State |
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