Provider Demographics
NPI:1114031820
Name:RICHARDS, BRADFORD C (PHD)
Entity Type:Individual
Prefix:DR
First Name:BRADFORD
Middle Name:C
Last Name:RICHARDS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 SAN RAFAEL AVE. NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87122-1116
Mailing Address - Country:US
Mailing Address - Phone:505-823-1600
Mailing Address - Fax:505-823-1161
Practice Address - Street 1:1 SAN RAFAEL AVE. NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87122-1116
Practice Address - Country:US
Practice Address - Phone:505-823-1600
Practice Address - Fax:505-823-1161
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2009-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0855103TC0700X
NM#0855103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM24738034Medicaid
NM339436301Medicare ID - Type Unspecified
P99035Medicare UPIN
NM24738034Medicaid