Provider Demographics
NPI:1538180971
Name:RICHMOND, BRIAN ROGERS (RN, LCPC)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:ROGERS
Last Name:RICHMOND
Suffix:
Gender:M
Credentials:RN, LCPC
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 3048
Mailing Address - Street 2:
Mailing Address - City:SKOWHEGAN
Mailing Address - State:ME
Mailing Address - Zip Code:04976-3048
Mailing Address - Country:US
Mailing Address - Phone:207-474-9644
Mailing Address - Fax:
Practice Address - Street 1:316 WATER ST
Practice Address - Street 2:
Practice Address - City:SKOWHEGAN
Practice Address - State:ME
Practice Address - Zip Code:04976-1734
Practice Address - Country:US
Practice Address - Phone:207-474-9644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC535101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional