MEDICARE: MS. PAULINE ANN RICHARD L.C.S.W.

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	1074	AK

General Provider Information

NPI Number	:	1528335528
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. PAULINE ANN RICHARD L.C.S.W.

Provider Business Mailing Address
First Line	:	PO BOX 132
Second Line	:
City	:	SUTTON
State	:	AK
Zip	:	99674-0132
Country	:	US
Telephone Number	:	907-746-7521
Fax Number	:	907-746-7531

Provider Business Practice Location Address
First Line	:	12159 N. JONESVILLE MINE RD.
Second Line	:
City	:	SUTTON
State	:	AK
Zip	:	99674-0132
Country	:	US
Telephone Number	:	907-746-7521
Fax Number	:	907-746-7531

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

Provider Enumeration Date	:	11/19/2011
Last Update Date	:	11/19/2011

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