Provider Demographics
NPI:1407985716
Name:DUVALL, RICHARD LEIGH (PHD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:LEIGH
Last Name:DUVALL
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 1:1420 MAIN ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-3110
Mailing Address - Country:US
Mailing Address - Phone:860-633-9491
Mailing Address - Fax:860-633-9491
Practice Address - Street 1:1420 MAIN ST
Practice Address - Street 2:SUITE 201
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-3110
Practice Address - Country:US
Practice Address - Phone:860-633-9491
Practice Address - Fax:860-633-9491
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-04
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1147103TC0700X
CT593106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT680000071Medicare ID - Type Unspecified