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General NPI Number Information
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NPI Number | 1538529821
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Entity Type | Individual
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Provider Name | MARK RICHARDSON PSY.D
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Gender | Male
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Dates
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Enumeration Date | 02/29/2016
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Last Update Date | 02/29/2016
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Provider Practice Location Address
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Address Line | 1301 E 12TH ST
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City | WILMINGTON
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State | DE
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Zip | 19802-5315
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Country | US
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Telephone | 302-429-7780
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Fax |
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Provider Business Mailing Address
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Address Line | 1114 S DUPONT HWY SUITE 104
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City | DOVER
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State | DE
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Zip | 19901-4401
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | B1-0000989
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License Number State | DE
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PS017632
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License Number State | PA
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