Provider Demographics
NPI:1245704337
Name:RICHBERG, SOLOMON RASHAWN III
Entity type:Individual
Prefix:MR
First Name:SOLOMON
Middle Name:RASHAWN
Last Name:RICHBERG
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7242 KENSINGTON HIGH BLVD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32818-3015
Mailing Address - Country:US
Mailing Address - Phone:497-247-2933
Mailing Address - Fax:
Practice Address - Street 1:7242 KENSINGTON HIGH BLVD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32818-3015
Practice Address - Country:US
Practice Address - Phone:407-247-9333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-11
Last Update Date:2022-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
FLSW171841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1053470385OtherNPI