Provider Demographics
NPI:1356427637
Name:RICHARDS, DANIEL L (PHD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:L
Last Name:RICHARDS
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 1:257 AUBURN ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-2137
Mailing Address - Country:US
Mailing Address - Phone:207-712-0497
Mailing Address - Fax:
Practice Address - Street 1:257 AUBURN ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-2137
Practice Address - Country:US
Practice Address - Phone:207-712-0497
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC86101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME061449OtherANTHEM
ME5420284OtherAETNA