Provider Demographics
NPI:1629084645
Name:PARKER, RICHARD JACKSON (PHD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:JACKSON
Last Name:PARKER
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 1:72 FRONT ST
Mailing Address - Street 2:
Mailing Address - City:BATH
Mailing Address - State:ME
Mailing Address - Zip Code:04530-2657
Mailing Address - Country:US
Mailing Address - Phone:207-443-6180
Mailing Address - Fax:207-443-6180
Practice Address - Street 1:72 FRONT ST
Practice Address - Street 2:
Practice Address - City:BATH
Practice Address - State:ME
Practice Address - Zip Code:04530-2657
Practice Address - Country:US
Practice Address - Phone:207-443-6180
Practice Address - Fax:207-443-6180
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPS393103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME6806Z040993ME1OtherANTHEM BLUE CROSS BLUE SH
ME708533Medicare ID - Type UnspecifiedPSYCHOLOGIST