Provider Demographics
NPI:1295725034
Name:NAY, RICHARD E (PHD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:E
Last Name:NAY
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:PO BOX 23040
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32241-3040
Mailing Address - Country:US
Mailing Address - Phone:904-886-4998
Mailing Address - Fax:904-292-1094
Practice Address - Street 1:2970 HARTLEY RD
Practice Address - Street 2:STE 201
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257-8227
Practice Address - Country:US
Practice Address - Phone:904-886-4998
Practice Address - Fax:904-292-1094
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-24
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY0004562103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK5266Medicare PIN
59615Medicare ID - Type Unspecified