MEDICARE: SOPHIA L RICHMILLER 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	12205-123	WI

General Provider Information

NPI Number	:	1205622180
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SOPHIA L RICHMILLER LCSW

Provider Business Mailing Address
First Line	:	1902 N COMMERCE ST APT 209
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53212-3490
Country	:	US
Telephone Number	:	217-440-0076
Fax Number	:

Provider Business Practice Location Address
First Line	:	1902 N COMMERCE ST APT 209
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53212-3490
Country	:	US
Telephone Number	:	217-440-0076
Fax Number	:

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

Provider Enumeration Date	:	04/16/2025
Last Update Date	:	04/16/2025

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