Provider Demographics
NPI:1336196294
Name:BINDEWALD, RICHARD P JR (LCP, PHD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:P
Last Name:BINDEWALD
Suffix:JR
Gender:F
Credentials:LCP, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 1279
Mailing Address - Street 2:
Mailing Address - City:GRETNA
Mailing Address - State:VA
Mailing Address - Zip Code:24557-1279
Mailing Address - Country:US
Mailing Address - Phone:434-836-2260
Mailing Address - Fax:434-836-1783
Practice Address - Street 1:110 HENRY STREET
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:VA
Practice Address - Zip Code:24557-4201
Practice Address - Country:US
Practice Address - Phone:434-836-2260
Practice Address - Fax:434-836-1783
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810001193103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA007714611Medicaid
VAR89343Medicare UPIN