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NPI Code Detail

MEDICARE: THERESA RENEE RICHARDSON LISW

MEDICARE:   THERESA RENEE RICHARDSON  LISW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social WorkerI.0700297OH

General Provider Information

NPI Number : 1811183122
Entity Type Code : Individual
Provider Name (Legal Business Name) : THERESA RENEE RICHARDSON LISW
Provider Business Mailing Address
First Line : 351 DYSAR RUN DR
Second Line :
City : BLACKLICK
State : OH
Zip : 43004-7084
Country : US
Telephone Number : 614-762-3093
Fax Number :
Provider Business Practice Location Address
First Line : 40 SPRUCE ST
Second Line :
City : COLUMBUS
State : OH
Zip : 43215-2204
Country : US
Telephone Number : 614-227-6865
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/20/2007
Last Update Date : 09/20/2007

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Directions to “ THERESA RENEE RICHARDSON LISW” Practice Location

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