Provider Demographics
NPI:1326257908
Name:WARREN, RICHARD K (PHD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:K
Last Name:WARREN
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:PO BOX 57
Mailing Address - Street 2:
Mailing Address - City:EXETER
Mailing Address - State:NH
Mailing Address - Zip Code:03833-0057
Mailing Address - Country:US
Mailing Address - Phone:603-778-7433
Mailing Address - Fax:603-778-0022
Practice Address - Street 1:24 FRONT ST
Practice Address - Street 2:SUITE 314
Practice Address - City:EXETER
Practice Address - State:NH
Practice Address - Zip Code:03833-2727
Practice Address - Country:US
Practice Address - Phone:603-778-7433
Practice Address - Fax:603-778-0022
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2020-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH590103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30420532Medicaid
NHRE1809Medicare ID - Type Unspecified
NH30420532Medicaid