Healthcare Provider Details

I. General information

NPI: 1427422054
Provider Name (Legal Business Name): EDWARD RICHTER LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/19/2015
Last Update Date: 04/10/2024
Certification Date: 04/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2817 ROCK MERRIT AVE
FORT LIBERTY NC
28310-0001
US

IV. Provider business mailing address

1650 COCHRANE CIR # B7500
FORT CARSON CO
80913-4613
US

V. Phone/Fax

Practice location:
  • Phone: 910-907-7525
  • Fax:
Mailing address:
  • Phone: 719-524-6099
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.016471
License Number StateIL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier149.016471
Identifier TypeOTHER
Identifier StateIL
Identifier IssuerMILITARY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: