MEDICARE: MS. PAMELA P RICHEY LICSW

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	14577	MN

General Provider Information

NPI Number	:	1851639678
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. PAMELA P RICHEY LICSW

Provider Business Mailing Address
First Line	:	3131 EXCELSIOR BLVD
Second Line	:	411
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55416-4600
Country	:	US
Telephone Number	:	612-462-4035
Fax Number	:

Provider Business Practice Location Address
First Line	:	3131 EXCELSIOR BLVD
Second Line	:	411
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55416-4600
Country	:	US
Telephone Number	:	612-462-4035
Fax Number	:

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

Provider Enumeration Date	:	01/29/2013
Last Update Date	:	01/29/2013

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