Provider Demographics
NPI:1255496527
Name:KOFSKY, RICHARD DAVID (PHD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:DAVID
Last Name:KOFSKY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9701 SANDRA LN
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55305-4632
Mailing Address - Country:US
Mailing Address - Phone:952-935-7864
Mailing Address - Fax:952-935-7864
Practice Address - Street 1:9701 SANDRA LN
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55305-4632
Practice Address - Country:US
Practice Address - Phone:952-935-7864
Practice Address - Fax:952-935-7864
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP2471103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN572024900Medicaid
MN6169755OtherUNITED BEHAVIORAL HEALTH
MN9H438KOOtherBLUE CROSS AND BLUE SHIEL
MN6169755OtherUNITED BEHAVIORAL HEALTH