MEDICARE: VANESSA RICHARDSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker
2	1041C0700X	Clinical Social Worker	SW20800	FL
3	101YM0800X	Mental Health Counselor	SW20800	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003351453
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VANESSA RICHARDSON

Provider Business Mailing Address
First Line	:	PO BOX 13481
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34979-3481
Country	:	US
Telephone Number	:	561-352-0877
Fax Number	:

Provider Business Practice Location Address
First Line	:	PO BOX 13481
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34979-3481
Country	:	US
Telephone Number	:	561-352-0877
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/21/2016
Last Update Date	:	06/04/2024

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Directions to “ VANESSA RICHARDSON ” Practice Location

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