Provider Demographics
NPI:1154201283
Name:RICHARDSON, CHASTON ALEXANDER (LMSW)
Entity type:Individual
Prefix:
First Name:CHASTON
Middle Name:ALEXANDER
Last Name:RICHARDSON
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 STANWIX ST APT A
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12209-1923
Mailing Address - Country:US
Mailing Address - Phone:518-396-3520
Mailing Address - Fax:
Practice Address - Street 1:25 VAN RENSSELAER DR
Practice Address - Street 2:
Practice Address - City:RENSSELAER
Practice Address - State:NY
Practice Address - Zip Code:12144-1491
Practice Address - Country:US
Practice Address - Phone:518-396-3520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-08
Last Update Date:2025-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY123102-011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical