Basic Information
Provider Information
NPI: 1881887081
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: DAY
FirstName: RICHARD
MiddleName: R.
NamePrefix: DR.
NameSuffix:  
Credential: PH.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 4101 PARKER AVE
Address2:  
City: WEST PALM BEACH
State: FL
PostalCode: 334052507
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 4101 PARKER AVE
Address2:  
City: WEST PALM BEACH
State: FL
PostalCode: 334052507
CountryCode: US
TelephoneNumber: 5616161222
FaxNumber: 5616161234
Other Information
ProviderEnumerationDate: 08/21/2007
LastUpdateDate: 08/21/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YA0400XPMH 761FLY Behavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)

No ID Information.


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