Healthcare Provider Details

I. General information

NPI: 1861622110
Provider Name (Legal Business Name): PATRICIA RICHARDSON MSW, LICSW, LMFT, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2009
Last Update Date: 01/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 DIVISION ST S STE C
NORTHFIELD MN
55057-2096
US

IV. Provider business mailing address

401 DIVISION ST S STE C
NORTHFIELD MN
55057-2096
US

V. Phone/Fax

Practice location:
  • Phone: 507-645-5644
  • Fax: 507-645-9291
Mailing address:
  • Phone: 507-645-5644
  • Fax: 507-645-9291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: PATRICIA ANN RICHARDSON
Title or Position: OWNER
Credential: MSW, LICSW, LMFT
Phone: 507-645-5644