Provider Demographics
NPI:1114970845
Name:ARNOLD, RICHARD RUSSELL (PH D)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:RUSSELL
Last Name:ARNOLD
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:PO BOX 95
Mailing Address - Street 2:10974 MILL STREET
Mailing Address - City:SWAIN
Mailing Address - State:NY
Mailing Address - Zip Code:14884-0095
Mailing Address - Country:US
Mailing Address - Phone:607-545-8562
Mailing Address - Fax:
Practice Address - Street 1:10974 MILL STREET
Practice Address - Street 2:10974 MILL STREET
Practice Address - City:SWAIN
Practice Address - State:NY
Practice Address - Zip Code:14884
Practice Address - Country:US
Practice Address - Phone:607-545-8562
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2010-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003954UPD103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY37071BMedicare PIN