Healthcare Provider Details

I. General information

NPI: 1508985656
Provider Name (Legal Business Name): KIMBERLY ANN RICHARDSON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 11/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 W BRIGGSMORE AVE STE I
MODESTO CA
95350-3839
US

IV. Provider business mailing address

2000 W BRIGGSMORE AVE STE I
MODESTO CA
95350-3839
US

V. Phone/Fax

Practice location:
  • Phone: 209-526-1440
  • Fax: 209-526-0908
Mailing address:
  • Phone: 209-526-1440
  • Fax: 209-526-0908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number29532
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: