Provider Demographics
NPI:1356420814
Name:RICHARDS, MARIANNE C (PHD)
Entity type:Individual
Prefix:
First Name:MARIANNE
Middle Name:C
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 ALLENS CREEK RD
Mailing Address - Street 2:BLDG 1, SUITE 104
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-3250
Mailing Address - Country:US
Mailing Address - Phone:585-271-7680
Mailing Address - Fax:585-351-2406
Practice Address - Street 1:95 ALLENS CREEK RD
Practice Address - Street 2:BLDG 1, SUITE 104
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-3250
Practice Address - Country:US
Practice Address - Phone:585-271-7680
Practice Address - Fax:585-351-2406
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY68014007103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist