Provider Demographics
NPI:1669447603
Name:GARNETT, RICHARD DAVID (PHD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:DAVID
Last Name:GARNETT
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 1:133 SARATOGA RD
Mailing Address - Street 2:PROFESSIONAL BUILDING, SUITE 3
Mailing Address - City:GLENVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12302-4108
Mailing Address - Country:US
Mailing Address - Phone:518-399-4051
Mailing Address - Fax:518-399-5447
Practice Address - Street 1:133 SARATOGA RD
Practice Address - Street 2:PROFESSIONAL BUILDING, SUITE 3
Practice Address - City:GLENVILLE
Practice Address - State:NY
Practice Address - Zip Code:12302-4108
Practice Address - Country:US
Practice Address - Phone:518-399-4051
Practice Address - Fax:518-399-5447
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5312103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000490835001OtherBLUE SHIELD NENY PROVIDE#
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NY41104OtherMVP PROVIDER NUMBER
NY00712189Medicaid
NY37840OtherCIGNA PROVIDER NUMBER
NY131941OtherVALUE OPTIONS PROVIDER #
NYS05312-4OtherNYS WORKER'S COMP #
NY33899BMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER