Provider Demographics
NPI:1891721809
Name:MONAHAN, RICHARD THOMAS (PHD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:THOMAS
Last Name:MONAHAN
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 1:147 POWERS RD
Mailing Address - Street 2:
Mailing Address - City:SUDBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01776-1043
Mailing Address - Country:US
Mailing Address - Phone:508-653-6518
Mailing Address - Fax:978-443-9660
Practice Address - Street 1:147 POWERS RD
Practice Address - Street 2:
Practice Address - City:SUDBURY
Practice Address - State:MA
Practice Address - Zip Code:01776-1043
Practice Address - Country:US
Practice Address - Phone:508-653-6518
Practice Address - Fax:978-443-9660
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPSY 1367103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0507512Medicaid
MA712076OtherTUFTS HEALTH PLAN
MAW01236OtherBLUE CROSS BLUE SHIELD
MA0507512Medicaid