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General NPI Number Information
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NPI Number | 1902386196
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Entity Type | Individual
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Provider Name | KATHRYN ROSE RICHIE LCSW, CADC
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Gender | Female
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Dates
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Enumeration Date | 08/16/2018
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Last Update Date | 12/31/2018
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Provider Practice Location Address
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Address Line | 1800 N HERMITAGE AVE
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City | CHICAGO
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State | IL
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Zip | 60622-1161
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Country | US
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Telephone | 312-948-6533
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Fax | 312-382-1612
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Provider Business Mailing Address
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Address Line | 1514 N WOOD ST # 2N
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City | CHICAGO
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State | IL
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Zip | 60622-2011
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Country | US
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Telephone | 507-210-9769
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149.020312
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License Number State | IL
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