Provider Demographics
NPI:1891886321
Name:PARADISE, RICHARD (PHD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:
Last Name:PARADISE
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 1:33 ELECTRIC AVE STE 205
Mailing Address - Street 2:
Mailing Address - City:FITCHBURG
Mailing Address - State:MA
Mailing Address - Zip Code:01420-7954
Mailing Address - Country:US
Mailing Address - Phone:978-343-3001
Mailing Address - Fax:
Practice Address - Street 1:33 ELECTRIC AVE STE 205
Practice Address - Street 2:
Practice Address - City:FITCHBURG
Practice Address - State:MA
Practice Address - Zip Code:01420-7954
Practice Address - Country:US
Practice Address - Phone:978-343-3001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2534103TC0700X, 103TA0400X, 103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
Not Answered103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1013200OtherBEACON HEALTH SYSTEMS
MA104248OtherMAGELLAN BEHAVIORAL HEALT
MA715822OtherTUFTS HEALTH PLAN
MA715822OtherTUFTS HEALTH PLAN