| Doctor Name: | DR. MARILYN ANDERSEN RICHARD |
| NPI Number: | 1649352790 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | APRN |
| License Number: | 000795 |
| Business Practice Address: | 333 Colonel Ledyard Hwy Ledyard, CT - 063391909 |
| Business Phone Number: | 8605727556 |
| Business Fax Number: | 8605722976 |
| Mailing Address: | 333 Colonel Ledyard Hwy, LEDYARD |
| State: | CT |
| Postal Code: | 063391909 |
| Phone Number: | 8605727556 |
| Fax Number: | 8605722976 |
| NPI Enumeration Date: | 10/19/2006 |
| NPI Last Update Date: | 12/07/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LP0808X |
| License Number: | 000795 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CT |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Psych/Mental Health |
| Taxonomy Definition: | |