Provider Demographics
NPI:1992860647
Name:LERNER, RICHARD A (PHD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:A
Last Name:LERNER
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 1:4 DICKS LN
Mailing Address - Street 2:
Mailing Address - City:ROSLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11576-2004
Mailing Address - Country:US
Mailing Address - Phone:516-621-1802
Mailing Address - Fax:
Practice Address - Street 1:4 DICKS LN # 5
Practice Address - Street 2:
Practice Address - City:ROSLYN
Practice Address - State:NY
Practice Address - Zip Code:11576-2004
Practice Address - Country:US
Practice Address - Phone:516-621-1802
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-23
Last Update Date:2010-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003415103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYVALUEOPT#132905OtherMANAGED CARE PROGRAM