Provider Demographics
NPI:1164454294
Name:STAPLES, RICHARD BRUCE (CAGS, LMHC)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:BRUCE
Last Name:STAPLES
Suffix:
Gender:M
Credentials:CAGS, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 MARTINACK AVE
Mailing Address - Street 2:
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-6449
Mailing Address - Country:US
Mailing Address - Phone:978-815-1570
Mailing Address - Fax:978-531-6244
Practice Address - Street 1:28 1/2 PEABODY SQ
Practice Address - Street 2:
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-5655
Practice Address - Country:US
Practice Address - Phone:978-815-1570
Practice Address - Fax:978-531-6244
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA63101YM0800X
MA289705103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9412132OtherPHCS PROVIDER ID NUMBER
MALM1224OtherBLUE CROSS/BLUE SHIELD