Provider Demographics
NPI:1659611051
Name:JONES, RICHARD RUDOLPH (CASAC)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:RUDOLPH
Last Name:JONES
Suffix:
Gender:M
Credentials:CASAC
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 1091
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10551-1091
Mailing Address - Country:US
Mailing Address - Phone:914-665-8085
Mailing Address - Fax:
Practice Address - Street 1:110 NO. 10TH. AVE. APT.#7X
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10551
Practice Address - Country:US
Practice Address - Phone:914-665-8085
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-21
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY13310101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)