Provider Demographics
NPI:1396838785
Name:RECKMAN, RICHARD FRED (PHD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:FRED
Last Name:RECKMAN
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 1:39 WALNUT AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45215-4335
Mailing Address - Country:US
Mailing Address - Phone:513-821-8421
Mailing Address - Fax:
Practice Address - Street 1:4450 CARVER WOODS DR
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242-5527
Practice Address - Country:US
Practice Address - Phone:513-984-9940
Practice Address - Fax:513-984-9858
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2775103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist