Provider Demographics
NPI:1962626614
Name:NOBEL, C. RICHARD (PSYD)
Entity Type:Individual
Prefix:DR
First Name:C.
Middle Name:RICHARD
Last Name:NOBEL
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:649 JONES RD
Mailing Address - Street 2:
Mailing Address - City:VESTAL
Mailing Address - State:NY
Mailing Address - Zip Code:13850-5226
Mailing Address - Country:US
Mailing Address - Phone:607-379-0045
Mailing Address - Fax:607-748-7997
Practice Address - Street 1:649 JONES RD
Practice Address - Street 2:
Practice Address - City:VESTAL
Practice Address - State:NY
Practice Address - Zip Code:13850-5226
Practice Address - Country:US
Practice Address - Phone:607-379-0045
Practice Address - Fax:607-748-7997
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010936103TC0700X
PAPS005849L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01694540Medicaid
NY01694540Medicaid