Healthcare Provider Details

I. General information

NPI: 1144348715
Provider Name (Legal Business Name): ALISSON L RICHARDS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 09/05/2024
Certification Date: 09/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 423
JERICHO VT
05465-0423
US

IV. Provider business mailing address

PO BOX 423
JERICHO VT
05465-0423
US

V. Phone/Fax

Practice location:
  • Phone: 802-232-2672
  • Fax: 802-404-9879
Mailing address:
  • Phone: 802-232-2672
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number042-0011999
License Number StateVT
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number042.0011999
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: