Provider Demographics
NPI:1356390835
Name:ALLOY, RICHARD (PHD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:
Last Name:ALLOY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9099 SOQUEL DR
Mailing Address - Street 2:SUITE 12
Mailing Address - City:APTOS
Mailing Address - State:CA
Mailing Address - Zip Code:95003-4033
Mailing Address - Country:US
Mailing Address - Phone:831-688-5010
Mailing Address - Fax:831-688-3676
Practice Address - Street 1:9099 SOQUEL DR
Practice Address - Street 2:SUITE 12
Practice Address - City:APTOS
Practice Address - State:CA
Practice Address - Zip Code:95003-4033
Practice Address - Country:US
Practice Address - Phone:831-688-5010
Practice Address - Fax:831-688-3676
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY7159103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOOPL71592Medicare ID - Type Unspecified
CAR27664Medicare UPIN