Provider Demographics
NPI:1710101290
Name:RICH, DEBORAH (PHD, LP)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:
Last Name:RICH
Suffix:
Gender:F
Credentials:PHD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1619 DAYTON AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-6276
Mailing Address - Country:US
Mailing Address - Phone:651-645-5504
Mailing Address - Fax:651-404-2512
Practice Address - Street 1:1619 DAYTON AVE STE 201
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104
Practice Address - Country:US
Practice Address - Phone:651-645-5504
Practice Address - Fax:651-404-2512
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1281103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN18G09RIOtherBLUE CROSS BS PIN NUMBER
MN18G08RIOtherBLUE CROSS BS GROUP NUMBE