Provider Demographics
NPI:1427005321
Name:RIECH, ELLEN BRANDFON (PHD)
Entity Type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:BRANDFON
Last Name:RIECH
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 1:6630 N 47TH AVE
Mailing Address - Street 2:SUITE 6
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85301-4172
Mailing Address - Country:US
Mailing Address - Phone:602-957-2710
Mailing Address - Fax:623-934-5895
Practice Address - Street 1:6630 N 47TH AVE
Practice Address - Street 2:SUITE 6
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85301-4172
Practice Address - Country:US
Practice Address - Phone:602-957-2710
Practice Address - Fax:623-934-5895
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1161103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist