Provider Demographics
NPI:1548334717
Name:RICHMOND, ALICIA CANDICE (LCSW-R)
Entity type:Individual
Prefix:MISS
First Name:ALICIA
Middle Name:CANDICE
Last Name:RICHMOND
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1416 COPPER RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-8113
Mailing Address - Country:US
Mailing Address - Phone:845-392-1405
Mailing Address - Fax:
Practice Address - Street 1:1416 COPPER RIDGE DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-8113
Practice Address - Country:US
Practice Address - Phone:845-392-1405
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2022-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY072883-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
N7X501Medicare UPIN
NYP86663Medicare UPIN