MEDICARE: BELYN MARIE RICHARDS

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	175T00000X	Peer Specialist
2	171M00000X	Case Manager/Care Coordinator	1104156207	CA

General Provider Information

NPI Number	:	1104156207
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BELYN MARIE RICHARDS

Provider Business Mailing Address
First Line	:	3780 ROSIN CT STE 110
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95834-1698
Country	:	US
Telephone Number	:	916-441-0226
Fax Number	:

Provider Business Practice Location Address
First Line	:	4433 FLORIN RD # 600
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95823-2527
Country	:	US
Telephone Number	:	916-234-2577
Fax Number	:

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

Provider Enumeration Date	:	01/12/2010
Last Update Date	:	05/24/2022

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