Provider Demographics
NPI:1669627477
Name:GAUDET, RICHARD ALBERT (PSYD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:ALBERT
Last Name:GAUDET
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 1:535 WALNUT LN
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19128-1742
Mailing Address - Country:US
Mailing Address - Phone:215-298-4515
Mailing Address - Fax:
Practice Address - Street 1:535 WALNUT LN
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19128-1742
Practice Address - Country:US
Practice Address - Phone:215-298-4515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-20
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPSO 16156103T00000X
FLPY 00052525103T00000X
NJ35S100457500103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic