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NPI Code Detail

MEDICARE: PENELOPE C. RICHARD MSW

MEDICARE: PENELOPE C. RICHARD MSW
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
11041C0700XClinical Social Worker001726CT

General Provider Information

NPI Number : 1841563699
Entity Type Code : Individual
Provider Name (Legal Business Name) : PENELOPE C. RICHARD MSW
Provider Business Mailing Address
First Line : 6 KARI CT
Second Line :
City : WINDSOR
State : CT
Zip : 06095-3576
Country : US
Telephone Number : 860-874-9097
Fax Number :
Provider Business Practice Location Address
First Line : 128 GARDEN ST
Second Line :
City : FARMINGTON
State : CT
Zip : 06032-2254
Country : US
Telephone Number : 860-874-9097
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/09/2012
Last Update Date : 02/09/2012

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