Healthcare Provider Details

I. General information

NPI: 1235580432
Provider Name (Legal Business Name): CLIFFORD RICHMOND MA, LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2016
Last Update Date: 06/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 OLD WEST CHESTER PIKE
HAVERTOWN PA
19083-2712
US

IV. Provider business mailing address

2000 OLD WEST CHESTER PIKE
HAVERTOWN PA
19083-2712
US

V. Phone/Fax

Practice location:
  • Phone: 484-454-8700
  • Fax:
Mailing address:
  • Phone: 484-454-8700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMF000790
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: