Healthcare Provider Details

I. General information

NPI: 1851632335
Provider Name (Legal Business Name): DEBRA ELAINE RICHARDSON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2013
Last Update Date: 06/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALIFORNIA MENS COLONY D QUAD HIGHWAY ONE
SAN LUIS OBISPO CA
93409-0001
US

IV. Provider business mailing address

PO BOX 13352
SAN LUIS OBISPO CA
93406-3352
US

V. Phone/Fax

Practice location:
  • Phone: 805-547-7900
  • Fax:
Mailing address:
  • Phone: 626-646-6520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS 15290
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: