Provider Demographics
NPI:1316216195
Name:RICHARD A GIANFAGNA, PH,D., P.C.
Entity Type:Organization
Organization Name:RICHARD A GIANFAGNA, PH,D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:GIANFAGNA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:765-935-5344
Mailing Address - Street 1:408 S 14TH ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-6403
Mailing Address - Country:US
Mailing Address - Phone:765-935-5344
Mailing Address - Fax:
Practice Address - Street 1:408 S 14TH ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-6403
Practice Address - Country:US
Practice Address - Phone:765-935-5344
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-22
Last Update Date:2012-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty