Provider Demographics
NPI:1760937098
Name:RONNER, RICHARD (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:RONNER
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2185 34TH AVE APT 6B
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11106-4329
Mailing Address - Country:US
Mailing Address - Phone:917-929-8430
Mailing Address - Fax:
Practice Address - Street 1:2185 34TH AVE APT 6B
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11106-4329
Practice Address - Country:US
Practice Address - Phone:917-929-8430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-16
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY402076363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY402076OtherNEW YORK STATE OFFICE OF THE PROFESSIONS NURSE PRACTITIONER LICENSE NUMBER