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: 07/12/2026
Certification Date: 07/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 E SUNRISE HWY STE 500-6306
VALLEY STREAM NY
11581-1240
US

IV. Provider business mailing address

70 E SUNRISE HWY STE 500-6306
VALLEY STREAM NY
11581-1240
US

V. Phone/Fax

Practice location:
  • Phone: 347-484-0106
  • Fax:
Mailing address:
  • Phone: 347-484-0106
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC06536300
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number091762
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: