Provider Demographics
NPI:1508847260
Name:GIANFAGNA, RICHARD ALAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:ALAN
Last Name:GIANFAGNA
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 1:408 S 14TH ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-6403
Mailing Address - Country:US
Mailing Address - Phone:765-935-5344
Mailing Address - Fax:765-966-8338
Practice Address - Street 1:408 S 14TH ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-6403
Practice Address - Country:US
Practice Address - Phone:765-935-5344
Practice Address - Fax:765-966-8338
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-09
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20010442A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100256150AMedicaid
IN904640Medicare ID - Type Unspecified