Provider Demographics
NPI:1477568335
Name:MAYS, RICHARD
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:MAYS
Suffix:
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 1:8757 108TH ST APT C4
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:NY
Mailing Address - Zip Code:11418-2227
Mailing Address - Country:US
Mailing Address - Phone:516-236-9415
Mailing Address - Fax:
Practice Address - Street 1:1219 CTY B
Practice Address - Street 2:
Practice Address - City:OLD CHATHAM
Practice Address - State:NY
Practice Address - Zip Code:12136
Practice Address - Country:US
Practice Address - Phone:516-776-6100
Practice Address - Fax:516-766-5471
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-29
Last Update Date:2009-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007700103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02596798Medicaid