Provider Demographics
NPI:1124028626
Name:RICHARDSON, PATRICK (PHD)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:
Last Name:RICHARDSON
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 1:17 FOUNDERS CT
Mailing Address - Street 2:
Mailing Address - City:COLD SPRING
Mailing Address - State:KY
Mailing Address - Zip Code:41076-1860
Mailing Address - Country:US
Mailing Address - Phone:859-781-7017
Mailing Address - Fax:
Practice Address - Street 1:200 MEDICAL VILLAGE DR
Practice Address - Street 2:
Practice Address - City:EDGEWOOD
Practice Address - State:KY
Practice Address - Zip Code:41017-3408
Practice Address - Country:US
Practice Address - Phone:859-578-5900
Practice Address - Fax:859-578-5940
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5236103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0687705Medicare ID - Type Unspecified
P62596Medicare UPIN