Provider Demographics
NPI:1578977617
Name:RICH, MEG (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MEG
Middle Name:
Last Name:RICH
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:
Other - Last Name:RICH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1140 BROADWAY
Mailing Address - Street 2:SUITE 204
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-7504
Mailing Address - Country:US
Mailing Address - Phone:714-584-7916
Mailing Address - Fax:
Practice Address - Street 1:1140 BROADWAY
Practice Address - Street 2:SUITE 204
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-7504
Practice Address - Country:US
Practice Address - Phone:714-584-7916
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-17
Last Update Date:2014-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020611103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical