Healthcare Provider Details

I. General information

NPI: 1407879968
Provider Name (Legal Business Name): SUSAN C RICHARDS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 05/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 BIRMINGHAM DR SUITE 1A1
CARDIFF BY THE SEA CA
92007-1758
US

IV. Provider business mailing address

PO BOX 3154
DEL MAR CA
92014-6154
US

V. Phone/Fax

Practice location:
  • Phone: 858-481-1237
  • Fax:
Mailing address:
  • Phone: 858-481-1237
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS 6794
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: