Healthcare Provider Details

I. General information

NPI: 1366573339
Provider Name (Legal Business Name): ALLISON TROY RICHARDSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALLISON TROY HECKL

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 07/11/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 VIA OREADA
CORRALES NM
87048
US

IV. Provider business mailing address

207 VIA OREADA
CORRALES NM
87048
US

V. Phone/Fax

Practice location:
  • Phone: 808-896-3485
  • Fax:
Mailing address:
  • Phone: 808-896-3485
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW26192
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI-08209
License Number StateNM
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSWC-08209
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: