Provider Demographics
NPI:1255439659
Name:STERNBERG, RICHARD R (PSYD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:R
Last Name:STERNBERG
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 1:1175 W BROADWAY
Mailing Address - Street 2:SUITE 21
Mailing Address - City:HEWLETT
Mailing Address - State:NY
Mailing Address - Zip Code:11557-1922
Mailing Address - Country:US
Mailing Address - Phone:516-569-3869
Mailing Address - Fax:516-569-0630
Practice Address - Street 1:1175 W BROADWAY
Practice Address - Street 2:SUITE 21
Practice Address - City:HEWLETT
Practice Address - State:NY
Practice Address - Zip Code:11557-1922
Practice Address - Country:US
Practice Address - Phone:516-569-3869
Practice Address - Fax:516-569-0630
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TA0700X, 103TC1900X, 103TF0200X, 103TP0814X
NY013016103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Not Answered103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
Not Answered103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysis
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01764823Medicaid
NYV92241Medicare UPIN