Provider Demographics
NPI:1780624197
Name:FOST, RICHARD JASON (PHD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:JASON
Last Name:FOST
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 1:134 CRAMER RD
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12603-6325
Mailing Address - Country:US
Mailing Address - Phone:845-452-4949
Mailing Address - Fax:845-452-8510
Practice Address - Street 1:12 DAVIS AVE
Practice Address - Street 2:SUITE 2N
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12603-2408
Practice Address - Country:US
Practice Address - Phone:845-452-4949
Practice Address - Fax:845-452-8510
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012365103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY243298OtherVALUEOPTIONS PROVIDER ID
NYP1017060OtherOXFORD PROVIDER ID
NY946918OtherMVP ID# (SOLE PROPRIETOR)
NY01578578Medicaid
NY192792OtherMHN PROVIDER ID
NY01578578Medicaid