Provider Demographics
NPI:1639107691
Name:SCHWARTZ, RICHARD D (PHD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:D
Last Name:SCHWARTZ
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:76 JUNIPER RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:FEEDING HILLS
Mailing Address - State:MA
Mailing Address - Zip Code:01030-1541
Mailing Address - Country:US
Mailing Address - Phone:413-786-3701
Mailing Address - Fax:413-786-3758
Practice Address - Street 1:46 SUFFIELD ST
Practice Address - Street 2:SUITE 4
Practice Address - City:AGAWAM
Practice Address - State:MA
Practice Address - Zip Code:01001-1753
Practice Address - Country:US
Practice Address - Phone:413-786-3701
Practice Address - Fax:413-786-3758
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2586103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0509795Medicaid
MA0509795Medicaid