Provider Demographics
NPI:1407900517
Name:RICHMOND, LINDA L (PHD)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:L
Last Name:RICHMOND
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 CATON AVE.,
Mailing Address - Street 2:6G
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11218
Mailing Address - Country:US
Mailing Address - Phone:845-987-0300
Mailing Address - Fax:
Practice Address - Street 1:625 CATON AVE.,
Practice Address - Street 2:6G
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11218
Practice Address - Country:US
Practice Address - Phone:845-987-0300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013250103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01787613Medicaid
P1013198OtherOXFORD HEALTH PLANS
NYV91771Medicare PIN