Provider Demographics
NPI:1356524904
Name:SALLICK, RICHARD MARSHALL (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:MARSHALL
Last Name:SALLICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:10 MOTT AVE
Mailing Address - Street 2:SUITE 3A
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06850-3320
Mailing Address - Country:US
Mailing Address - Phone:203-857-4536
Mailing Address - Fax:203-854-6987
Practice Address - Street 1:10 MOTT AVE
Practice Address - Street 2:3A
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06850-3320
Practice Address - Country:US
Practice Address - Phone:203-857-4536
Practice Address - Fax:203-854-6987
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-06
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT0156872084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry