Provider Demographics
NPI:1083737712
Name:RICHMAN, DIANA RUTH (PHD)
Entity Type:Individual
Prefix:DR
First Name:DIANA
Middle Name:RUTH
Last Name:RICHMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 71 PARK DRIVE EAST
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-2829
Mailing Address - Country:US
Mailing Address - Phone:718-263-6989
Mailing Address - Fax:
Practice Address - Street 1:109 23 71 ROAD
Practice Address - Street 2:SUITE 2J
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375
Practice Address - Country:US
Practice Address - Phone:718-263-6989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY6522103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
V56302Medicare ID - Type UnspecifiedMANHATTAN QUEENS
03342Medicare ID - Type UnspecifiedMANHATTAN QUEENS