Provider Demographics
NPI:1710262225
Name:DOUGLASS, RICHARD MARVIN (PSYCHOLOGIST)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:MARVIN
Last Name:DOUGLASS
Suffix:
Gender:M
Credentials:PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1614
Mailing Address - Street 2:
Mailing Address - City:PLEASANT VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:12569-1614
Mailing Address - Country:US
Mailing Address - Phone:845-723-4373
Mailing Address - Fax:845-635-5189
Practice Address - Street 1:1421 ROUTE 44
Practice Address - Street 2:
Practice Address - City:PLEASANT VALLEY
Practice Address - State:NY
Practice Address - Zip Code:12569-7832
Practice Address - Country:US
Practice Address - Phone:845-723-4373
Practice Address - Fax:845-635-5189
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-15
Last Update Date:2011-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY8375103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist