MEDICARE: DR. STEFAN RICHARD ZICHT PSY.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	012961	NY
2	103TP0814X	Psychoanalysis Psychologist	012961	NY

General Provider Information

NPI Number	:	1982824835
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEFAN RICHARD ZICHT PSY.D.

Provider Business Mailing Address
First Line	:	381 W END AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10024-6104
Country	:	US
Telephone Number	:	212-580-7262
Fax Number	:

Provider Business Practice Location Address
First Line	:	381 W END AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10024-6104
Country	:	US
Telephone Number	:	212-580-7262
Fax Number	:

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

Provider Enumeration Date	:	04/25/2007
Last Update Date	:	09/11/2025

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