Provider Demographics
NPI:1942471263
Name:CROSS, RICHARD W (PHD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:W
Last Name:CROSS
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 1:25 BURNCOAT ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-1800
Mailing Address - Country:US
Mailing Address - Phone:978-835-9284
Mailing Address - Fax:508-853-8205
Practice Address - Street 1:25 BURNCOAT ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-1800
Practice Address - Country:US
Practice Address - Phone:978-835-9284
Practice Address - Fax:508-853-8205
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-13
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8817103TB0200X, 103TC0700X
MA417919103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool