Provider Demographics
NPI:1003905787
Name:AZRIN, RICHARD L (PH D)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:L
Last Name:AZRIN
Suffix:
Gender:M
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4260 CAHABA HEIGHTS CT
Mailing Address - Street 2:STE 180
Mailing Address - City:VESTAVIA
Mailing Address - State:AL
Mailing Address - Zip Code:35243-5711
Mailing Address - Country:US
Mailing Address - Phone:053-297-8152
Mailing Address - Fax:205-329-7816
Practice Address - Street 1:4260 CAHABA HEIGHTS CT
Practice Address - Street 2:STE 180
Practice Address - City:VESTAVIA
Practice Address - State:AL
Practice Address - Zip Code:35243-5711
Practice Address - Country:US
Practice Address - Phone:053-297-8152
Practice Address - Fax:205-329-7816
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2019-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL819103TC0700X, 103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051501026OtherBLUE CROSS
AL051503120OtherFEDERAL BLUE CROSS
ALUS DEPART. OF LABOROther362466400