Doctor Name: | RICHARD EATON |
NPI Number: | 1205187085 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.S. |
License Number: | 351337 |
Business Practice Address: | 200 Center Street Moriarty, NM - 870352000 |
Business Phone Number: | 5058324471 |
Business Fax Number: | |
Mailing Address: | 200 Center Street, MORIARTY |
State: | NM |
Postal Code: | 870352000 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 09/20/2012 |
NPI Last Update Date: | 09/20/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TS0200X |
License Number: | 351337 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NM |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | School |
Taxonomy Definition: |