Healthcare Provider Details

I. General information

NPI: 1891242970
Provider Name (Legal Business Name): LORRAINE TANIA RICHARDSON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2016
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

418 BROADWAY STE N
ALBANY NY
12207-2922
US

IV. Provider business mailing address

418 BROADWAY STE N
ALBANY NY
12207-2922
US

V. Phone/Fax

Practice location:
  • Phone: 516-631-4818
  • Fax:
Mailing address:
  • Phone: 516-631-4818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904020838
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC06536300
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number35548
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC200004976
License Number StateDC
# 5
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number16522
License Number StateCT
# 6
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number091762
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: