Provider Demographics
NPI:1891092037
Name:RICH, PHIL (EDD, MSW)
Entity Type:Individual
Prefix:DR
First Name:PHIL
Middle Name:
Last Name:RICH
Suffix:
Gender:M
Credentials:EDD, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:187 SHUTESBURY RD
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:MA
Mailing Address - Zip Code:01002-1264
Mailing Address - Country:US
Mailing Address - Phone:978-355-4541
Mailing Address - Fax:978-355-2706
Practice Address - Street 1:455 SOUTH STREET
Practice Address - Street 2:STETSON SCHOOL
Practice Address - City:BARRE
Practice Address - State:MA
Practice Address - Zip Code:01005-0309
Practice Address - Country:US
Practice Address - Phone:978-355-4541
Practice Address - Fax:978-355-2706
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-24
Last Update Date:2011-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1053991041C0700X
CT0074711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical