Healthcare Provider Details

I. General information

NPI: 1346780764
Provider Name (Legal Business Name): DENISE RICHARDSON LMHC, CCTP2, CASAC2
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2017
Last Update Date: 06/08/2024
Certification Date: 06/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8400 SHORE FRONT PKWY APT 8C
ROCKAWAY BEACH NY
11693-1816
US

IV. Provider business mailing address

8400 SHORE FRONT PKWY APT 8C
ROCKAWAY BEACH NY
11693-1816
US

V. Phone/Fax

Practice location:
  • Phone: 646-436-6481
  • Fax: 718-945-2149
Mailing address:
  • Phone: 718-578-4246
  • Fax: 718-945-2149

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number18351
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number007158-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: