MEDICARE: MRS. RACHEL 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	103K00000X	Behavior Analyst	BH003850	PA

General Provider Information

NPI Number	:	1245712371
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. RACHEL RICHARDSON

Provider Business Mailing Address
First Line	:	1321 W 2ND ST
Second Line	:
City	:	WILMINGTON
State	:	DE
Zip	:	19805-3673
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	606 E BALTIMORE PIKE
Second Line	:
City	:	MEDIA
State	:	PA
Zip	:	19063-1751
Country	:	US
Telephone Number	:	610-356-4749
Fax Number	:

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

Provider Enumeration Date	:	09/05/2018
Last Update Date	:	09/05/2018

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