MEDICARE: MARIANNE C RICHARDS 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	68014007	NY
2	103TC0700X	Clinical Psychologist	68014007	NY

General Provider Information

NPI Number	:	1356420814
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIANNE C RICHARDS PH.D.

Provider Business Mailing Address
First Line	:	95 ALLENS CREEK RD
Second Line	:	BLDG 1, SUITE 104
City	:	ROCHESTER
State	:	NY
Zip	:	14618-3250
Country	:	US
Telephone Number	:	585-271-7680
Fax Number	:	585-351-2406

Provider Business Practice Location Address
First Line	:	95 ALLENS CREEK RD
Second Line	:	BLDG 1, SUITE 104
City	:	ROCHESTER
State	:	NY
Zip	:	14618-3250
Country	:	US
Telephone Number	:	585-271-7680
Fax Number	:	585-351-2406

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

Provider Enumeration Date	:	11/03/2006
Last Update Date	:	10/14/2010

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