Provider Demographics
NPI:1922200609
Name:RICHMOND BEHAVIORAL ASSOCIATES, LLC
Entity Type:Organization
Organization Name:RICHMOND BEHAVIORAL ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:DIBUONO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-317-5522
Mailing Address - Street 1:4349 HYLAN BLVD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-6501
Mailing Address - Country:US
Mailing Address - Phone:718-317-5522
Mailing Address - Fax:718-317-5919
Practice Address - Street 1:4349 HYLAN BLVD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312-6501
Practice Address - Country:US
Practice Address - Phone:718-317-5522
Practice Address - Fax:718-317-5919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-04
Last Update Date:2014-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1560592084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty