Provider Demographics
NPI:1467549717
Name:RICHMOND, LOUIS D (PHD)
Entity Type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:D
Last Name:RICHMOND
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 1:450 BLOOMFIELD AVE.
Mailing Address - Street 2:SUITE 201
Mailing Address - City:VERONA
Mailing Address - State:NJ
Mailing Address - Zip Code:07044-2000
Mailing Address - Country:US
Mailing Address - Phone:973-857-3113
Mailing Address - Fax:973-857-0249
Practice Address - Street 1:450 BLOOMFIELD AVE.
Practice Address - Street 2:SUITE 201
Practice Address - City:VERONA
Practice Address - State:NJ
Practice Address - Zip Code:07044-2000
Practice Address - Country:US
Practice Address - Phone:973-857-3113
Practice Address - Fax:973-857-0249
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJSI02811103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
189022OtherMHN
049945OtherVALUE OPTIONS
NJ4584902Medicaid
P2101539OtherOXFORD HEALTH
189022OtherMHN