Provider Demographics
NPI:1427407238
Name:RICHARD K. WILLENS, PSYD LLC
Entity Type:Organization
Organization Name:RICHARD K. WILLENS, PSYD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:KENNETH
Authorized Official - Last Name:WILLENS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:407-629-4356
Mailing Address - Street 1:1155 LOUISIANA AVE STE 106
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-2351
Mailing Address - Country:US
Mailing Address - Phone:406-629-4356
Mailing Address - Fax:
Practice Address - Street 1:1155 LOUISIANA AVE STE 106
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-2351
Practice Address - Country:US
Practice Address - Phone:406-629-4356
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-13
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Single Specialty