Healthcare Provider Details

I. General information

NPI: 1255656591
Provider Name (Legal Business Name): RICHARD C UNDERWOOD LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2010
Last Update Date: 03/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 NORTH PARK STREET, 2ND FLOOR
SENECA FALLS NY
13148-1437
US

IV. Provider business mailing address

12 NORTH PARK STREET, 2ND FLOOR
SENECA FALLS NY
13148-1437
US

V. Phone/Fax

Practice location:
  • Phone: 315-568-9412
  • Fax: 315-568-6718
Mailing address:
  • Phone: 315-568-9412
  • Fax: 315-568-6718

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number044263-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: