Provider Demographics
NPI:1760567135
Name:SIDLEY, RICHARD TUTHILL JR
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:TUTHILL
Last Name:SIDLEY
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:USAG BAMBERG
Mailing Address - Street 2:UNIT 27535 BOX 23681
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09139
Mailing Address - Country:DE
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:USAG BAMBERG
Practice Address - Street 2:UNIT 27535 BOX 23681
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09139
Practice Address - Country:DE
Practice Address - Phone:04-995-1300
Practice Address - Fax:049951-300-7964
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)