MEDICARE: GORDON RICHARDSON M.S.W., 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	LCSW 23895	CA

General Provider Information

NPI Number	:	1245248434
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GORDON RICHARDSON M.S.W., LCSW

Provider Business Mailing Address
First Line	:	9343 TECH CENTER DR FL 2
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95826-2563
Country	:	US
Telephone Number	:	916-388-6301
Fax Number	:	866-680-0843

Provider Business Practice Location Address
First Line	:	9343 TECH CENTER DR FL 2
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95826-2563
Country	:	US
Telephone Number	:	916-388-6301
Fax Number	:	866-680-0843

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

Provider Enumeration Date	:	08/03/2006
Last Update Date	:	10/22/2021

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