Healthcare Provider Details

I. General information

NPI: 1790486769
Provider Name (Legal Business Name): ANTONIO PAUL LUIS RICHARDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2023
Last Update Date: 03/15/2023
Certification Date: 03/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 SPRUCE ST
NORTH COLLINS NY
14111-9701
US

IV. Provider business mailing address

313 EAGLEHEAD RD
EAST ROCHESTER NY
14445-1607
US

V. Phone/Fax

Practice location:
  • Phone: 716-337-3706
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: