Provider Demographics
NPI:1891717526
Name:CROCKER, RICHARD R (PHD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:R
Last Name:CROCKER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 MASCOMA ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:NH
Mailing Address - Zip Code:03766-2629
Mailing Address - Country:US
Mailing Address - Phone:603-381-2564
Mailing Address - Fax:602-646-2645
Practice Address - Street 1:46 MASCOMA ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03766-2629
Practice Address - Country:US
Practice Address - Phone:603-381-2564
Practice Address - Fax:602-646-2645
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH63101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30424283Medicaid