Provider Demographics
NPI:1902332810
Name:YERRY, RICHARD (LCSW-R)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:YERRY
Suffix:
Gender:M
Credentials:LCSW-R
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 72
Mailing Address - Street 2:
Mailing Address - City:STONY CREEK
Mailing Address - State:NY
Mailing Address - Zip Code:12878-0072
Mailing Address - Country:US
Mailing Address - Phone:518-964-2061
Mailing Address - Fax:518-377-9151
Practice Address - Street 1:317 HADLEY RD
Practice Address - Street 2:
Practice Address - City:HADLEY
Practice Address - State:NY
Practice Address - Zip Code:12835-2703
Practice Address - Country:US
Practice Address - Phone:518-964-2061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-11
Last Update Date:2022-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0845111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical