Provider Demographics
NPI:1760590160
Name:FINK, RICHARD T (PHD)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:T
Last Name:FINK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 JOHNSON STREET
Mailing Address - Street 2:
Mailing Address - City:SANTE FE
Mailing Address - State:NM
Mailing Address - Zip Code:87501-1828
Mailing Address - Country:US
Mailing Address - Phone:505-983-3757
Mailing Address - Fax:505-982-3300
Practice Address - Street 1:301 JOHNSON STREET
Practice Address - Street 2:
Practice Address - City:SANTE FE
Practice Address - State:NM
Practice Address - Zip Code:87501-1828
Practice Address - Country:US
Practice Address - Phone:505-983-3757
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
R13354Medicare UPIN