Provider Demographics
NPI:1972530376
Name:RANEY, RICHARD WILTON (PHD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:WILTON
Last Name:RANEY
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 1:107 GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:NEW HARTFORD
Mailing Address - State:NY
Mailing Address - Zip Code:13413-2323
Mailing Address - Country:US
Mailing Address - Phone:315-738-0393
Mailing Address - Fax:315-738-1176
Practice Address - Street 1:107 GENESEE ST
Practice Address - Street 2:
Practice Address - City:NEW HARTFORD
Practice Address - State:NY
Practice Address - Zip Code:13413-2323
Practice Address - Country:US
Practice Address - Phone:315-738-0393
Practice Address - Fax:315-738-1176
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009216-1103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01047814Medicaid
NYR55419Medicare UPIN
NY01047814Medicaid