Provider Demographics
NPI:1659450724
Name:NARDINE, RICHARD L (PSYD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:L
Last Name:NARDINE
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5685
Mailing Address - Street 2:
Mailing Address - City:MARLBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01752-8685
Mailing Address - Country:US
Mailing Address - Phone:508-485-4856
Mailing Address - Fax:
Practice Address - Street 1:530 BOSTON POST ROAD
Practice Address - Street 2:SUITE B
Practice Address - City:MARLBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01752-8685
Practice Address - Country:US
Practice Address - Phone:508-485-4856
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4100103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA709049OtherTUFTS