MEDICARE: DR. RICHARD C KEVIN 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	103T00000X	Psychologist	1223	NC

General Provider Information

NPI Number	:	1225147572
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD C KEVIN PH.D.

Provider Business Mailing Address
First Line	:	3710 BENSON DR
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27609-7321
Country	:	US
Telephone Number	:	919-878-7800
Fax Number	:	919-878-9983

Provider Business Practice Location Address
First Line	:	3710 BENSON DR
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27609-7321
Country	:	US
Telephone Number	:	919-878-7800
Fax Number	:	919-878-9983

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

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	07/08/2007

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