Provider Demographics
NPI:1467661074
Name:KIDD, RICHARD A (LMFT)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:A
Last Name:KIDD
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 W SIERRA MADRE BLVD
Mailing Address - Street 2:STE. 200
Mailing Address - City:SIERRA MADRE
Mailing Address - State:CA
Mailing Address - Zip Code:91024-2462
Mailing Address - Country:US
Mailing Address - Phone:626-836-6561
Mailing Address - Fax:
Practice Address - Street 1:73 W SIERRA MADRE BLVD
Practice Address - Street 2:STE. 200
Practice Address - City:SIERRA MADRE
Practice Address - State:CA
Practice Address - Zip Code:91024-2462
Practice Address - Country:US
Practice Address - Phone:626-836-6561
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC25612106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist