Healthcare Provider Details

I. General information

NPI: 1265410310
Provider Name (Legal Business Name): ROBERTA M RICHARDSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2006
Last Update Date: 08/19/2021
Certification Date: 08/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 UNION BLVD STE 104
LAKEWOOD CO
80228-1808
US

IV. Provider business mailing address

PO BOX 717
EVERGREEN CO
80437-0717
US

V. Phone/Fax

Practice location:
  • Phone: 303-284-2262
  • Fax:
Mailing address:
  • Phone: 303-909-9142
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number26423
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number26423
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: