Provider Demographics
NPI:1457302648
Name:RICHARD, BEVERLY (PHD)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:
Last Name:RICHARD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
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Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1156 N BROADWAY
Mailing Address - Street 2:ANDRUS CHILDREN'S CENTER
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-1108
Mailing Address - Country:US
Mailing Address - Phone:914-965-3700
Mailing Address - Fax:914-965-3883
Practice Address - Street 1:19 GREENRIDGE AVE
Practice Address - Street 2:ANDRUS CHILDREN'S CENTER MENTAL HEALTH DIVISION
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10605-1201
Practice Address - Country:US
Practice Address - Phone:914-949-7680
Practice Address - Fax:914-997-7942
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY010243103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00355940Medicaid
NY010243OtherNYS PHD LICENSE #
NY1285628552OtherJDAM NPI #
NY00355940Medicaid