Provider Demographics
NPI:1902014186
Name:RICHDALE, SARAH (MS)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:RICHDALE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 75
Mailing Address - Street 2:
Mailing Address - City:CAMPTON
Mailing Address - State:NH
Mailing Address - Zip Code:03223-0075
Mailing Address - Country:US
Mailing Address - Phone:603-726-5136
Mailing Address - Fax:
Practice Address - Street 1:10 TSIENNETO RD
Practice Address - Street 2:
Practice Address - City:DERRY
Practice Address - State:NH
Practice Address - Zip Code:03038-1505
Practice Address - Country:US
Practice Address - Phone:603-965-0620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-19
Last Update Date:2014-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30931444Medicaid
NHRE6496Medicare ID - Type Unspecified