MEDICARE: MS. PAMELA RICHARDS LCSW

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	0904004972	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	088026M	OTHER	VA	SENARA - BRH
2	183971	OTHER	VA	ANTHEM - BRH

General Provider Information

NPI Number	:	1124128640
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. PAMELA RICHARDS LCSW

Provider Business Mailing Address
First Line	:	447 HICKORY LN
Second Line	:
City	:	WOODSTOCK
State	:	VA
Zip	:	22664-2175
Country	:	US
Telephone Number	:	540-244-9496
Fax Number	:

Provider Business Practice Location Address
First Line	:	11576 LEE HWY # G
Second Line	:
City	:	SPERRYVILLE
State	:	VA
Zip	:	22740-2163
Country	:	US
Telephone Number	:	540-987-3111
Fax Number	:

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

Provider Enumeration Date	:	09/24/2006
Last Update Date	:	07/08/2007

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