1902332810 NPI number — RICHARD YERRY LCSW-R

Table of content: RICHARD YERRY LCSW-R (NPI 1902332810)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902332810 NPI number — RICHARD YERRY LCSW-R

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
YERRY
Provider First Name:
RICHARD
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW-R
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1902332810
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/03/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 72
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STONY CREEK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12878-0072
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-964-2061
Provider Business Mailing Address Fax Number:
518-377-9151

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
317 HADLEY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HADLEY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12835-2703
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-964-2061
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/11/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  084511 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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