Provider Demographics
NPI:1437890639
Name:ALHAGE, RICHARD JOSEPH JR
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:JOSEPH
Last Name:ALHAGE
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 EAMES DR
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06478-1182
Mailing Address - Country:US
Mailing Address - Phone:203-704-0036
Mailing Address - Fax:
Practice Address - Street 1:MOUNTAINSIDE TREATMENT CENTER
Practice Address - Street 2:187 RT 7 SOUTH CANAAN RD
Practice Address - City:CANAAN
Practice Address - State:CT
Practice Address - Zip Code:06018
Practice Address - Country:US
Practice Address - Phone:860-632-1397
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-05
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT124829163WP0808X
CT12.011392363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health