MEDICARE: DR. RICHARD JASON FOST 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	012365	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	243298	OTHER	NY	VALUEOPTIONS PROVIDER ID
2	P1017060	OTHER	NY	OXFORD PROVIDER ID
3	946918	OTHER	NY	MVP ID# (SOLE PROPRIETOR)
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	192792	OTHER	NY	MHN PROVIDER ID

General Provider Information

NPI Number	:	1780624197
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD JASON FOST PH.D.

Provider Business Mailing Address
First Line	:	134 CRAMER RD
Second Line	:
City	:	POUGHKEEPSIE
State	:	NY
Zip	:	12603-6325
Country	:	US
Telephone Number	:	845-452-4949
Fax Number	:	845-452-8510

Provider Business Practice Location Address
First Line	:	12 DAVIS AVE
Second Line	:	SUITE 2N
City	:	POUGHKEEPSIE
State	:	NY
Zip	:	12603-2408
Country	:	US
Telephone Number	:	845-452-4949
Fax Number	:	845-452-8510

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

Provider Enumeration Date	:	06/07/2006
Last Update Date	:	07/09/2007

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