Healthcare Provider Details

I. General information

NPI: 1285313957
Provider Name (Legal Business Name): SHETARA RICHARDSON CAADC, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2023
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

722 E BUTLER PIKE
AMBLER PA
19002-2310
US

IV. Provider business mailing address

2901 WELSH RD
PHILADELPHIA PA
19152-1659
US

V. Phone/Fax

Practice location:
  • Phone: 215-643-7800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCW023741
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW023741
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: