Healthcare Provider Details

I. General information

NPI: 1689765208
Provider Name (Legal Business Name): DAVIS L RICHMOND LICSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 HANOVER ST
MANCHESTER NH
03101-2203
US

IV. Provider business mailing address

99 HANOVER ST PO BOX 448
MANCHESTER NH
03101-2203
US

V. Phone/Fax

Practice location:
  • Phone: 603-668-1920
  • Fax: 603-668-6260
Mailing address:
  • Phone: 603-668-1920
  • Fax: 603-668-6260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1233
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: