Provider Demographics
NPI:1558362590
Name:SOCWELL, RICHARD J (MS MSED)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:J
Last Name:SOCWELL
Suffix:
Gender:M
Credentials:MS MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 1ST ST NW
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52405
Mailing Address - Country:US
Mailing Address - Phone:319-396-1066
Mailing Address - Fax:319-396-8779
Practice Address - Street 1:3100 E AVE NW
Practice Address - Street 2:SUITE 101
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52405
Practice Address - Country:US
Practice Address - Phone:319-396-3110
Practice Address - Fax:319-396-8779
Is Sole Proprietor?:No
Enumeration Date:2005-08-01
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00529103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA14963OtherBCBS