Provider Demographics
NPI:1265453716
Name:TRACHTMAN, RICHARD (PHD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:
Last Name:TRACHTMAN
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 1:2166 BROADWAY
Mailing Address - Street 2:#20E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-6673
Mailing Address - Country:US
Mailing Address - Phone:121-259-5044
Mailing Address - Fax:121-272-1649
Practice Address - Street 1:2166 BROADWAY
Practice Address - Street 2:#20E
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-6673
Practice Address - Country:US
Practice Address - Phone:121-259-5044
Practice Address - Fax:121-272-1649
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR001205-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYNOB861Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER