Healthcare Provider Details

I. General information

NPI: 1225687817
Provider Name (Legal Business Name): KIMBERLEY RICHARDSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2019
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

347 SAINT PAUL ST APT 3
BROOKLINE MA
02446-3609
US

IV. Provider business mailing address

347 SAINT PAUL ST APT 3
BROOKLINE MA
02446-3609
US

V. Phone/Fax

Practice location:
  • Phone: 617-276-5625
  • Fax:
Mailing address:
  • Phone: 617-276-5625
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLICSW1120825
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number228146
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: