=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376636324
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LYDIA LM RICHARDS LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/02/2006
-----------------------------------------------------
Last Update Date | 04/24/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 25A FIRST PARK DRIVE
-----------------------------------------------------
City | OAKLAND
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04963-5370
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-873-4325
-----------------------------------------------------
Fax | 207-873-4344
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 25A FIRST PARK DRIVE
-----------------------------------------------------
City | OAKLAND
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04963
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-873-4325
-----------------------------------------------------
Fax | 207-873-4344
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | LC3449
-----------------------------------------------------
License Number State | ME
-----------------------------------------------------