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General NPI Number Information
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NPI Number | 1932114691
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Entity Type | Individual
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Provider Name | FRANKLIN RADDOCK PH.D.
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Gender | Male
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Dates
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Enumeration Date | 07/30/2006
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Last Update Date | 06/15/2015
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Provider Practice Location Address
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Address Line | 1745 BROADWAY 17 FL
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City | NEW YORK
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State | NY
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Zip | 10019-4640
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Country | US
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Telephone | 212-851-8100
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Fax | 212-537-0102
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Provider Business Mailing Address
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Address Line | 125 TURNER RD
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City | STAMFORD
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State | CT
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Zip | 06905-3604
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Country | US
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Telephone | 203-253-7883
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 6730
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License Number State | NY
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