Healthcare Provider Details

I. General information

NPI: 1497287403
Provider Name (Legal Business Name): LA SHAUNA RICHARDSON LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2017
Last Update Date: 05/07/2020
Certification Date: 05/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

82 CLIFFWOOD AVE UNIT 29
CLIFFWOOD NJ
07721-1082
US

IV. Provider business mailing address

82 CLIFFWOOD AVE UNIT 29
CLIFFWOOD NJ
07721-1082
US

V. Phone/Fax

Practice location:
  • Phone: 908-420-3986
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number44SL06034700
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number44SL060347000
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC05873100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: