MEDICARE: DR. DERYCK D'ARCY RICHARDSON PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	2950	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194887224
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DERYCK D'ARCY RICHARDSON PH.D.

Provider Business Mailing Address
First Line	:	1425 E DUBLIN GRANVILLE RD
Second Line	:	SUITE 204
City	:	COLUMBUS
State	:	OH
Zip	:	43229-3325
Country	:	US
Telephone Number	:	614-888-5255
Fax Number	:	614-888-2306

Provider Business Practice Location Address
First Line	:	1425 E DUBLIN GRANVILLE RD
Second Line	:	SUITE 204
City	:	COLUMBUS
State	:	OH
Zip	:	43229-3325
Country	:	US
Telephone Number	:	614-888-5255
Fax Number	:	614-888-2306

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/14/2006
Last Update Date	:	02/13/2013

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