Provider Demographics
NPI:1447454863
Name:RICHARD F. FORMICA, PH.D., P.A.
Entity type:Organization
Organization Name:RICHARD F. FORMICA, PH.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:F
Authorized Official - Last Name:FORMICA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:201-384-7457
Mailing Address - Street 1:73 MORRIS AVE
Mailing Address - Street 2:
Mailing Address - City:HAWORTH
Mailing Address - State:NJ
Mailing Address - Zip Code:07641-1303
Mailing Address - Country:US
Mailing Address - Phone:201-384-7457
Mailing Address - Fax:
Practice Address - Street 1:73 MORRIS AVE
Practice Address - Street 2:
Practice Address - City:HAWORTH
Practice Address - State:NJ
Practice Address - Zip Code:07641-1303
Practice Address - Country:US
Practice Address - Phone:201-384-7457
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35S100098200103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ35S100098200OtherNJ LICENSE #