Healthcare Provider Details

I. General information

NPI: 1235382284
Provider Name (Legal Business Name): JESSICA S. RICHARDS MS, MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA S. DANKO

II. Dates (important events)

Enumeration Date: 11/03/2008
Last Update Date: 05/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 N MARENGO AVE STE 100
PASADENA CA
91101-4550
US

IV. Provider business mailing address

95 N MARENGO AVE STE 100
PASADENA CA
91101-4550
US

V. Phone/Fax

Practice location:
  • Phone: 626-765-1335
  • Fax:
Mailing address:
  • Phone: 626-765-1335
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberASW24946
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number27379
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: