Provider Demographics
NPI:1861113896
Name:RICHARDS, JENNIFER T (LCAT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:T
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:LCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23-58 98 STREET
Mailing Address - Street 2:
Mailing Address - City:EAST ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11369
Mailing Address - Country:US
Mailing Address - Phone:718-898-9895
Mailing Address - Fax:
Practice Address - Street 1:23-58 98 STREET
Practice Address - Street 2:
Practice Address - City:EAST ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11369
Practice Address - Country:US
Practice Address - Phone:718-898-9895
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-07
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1877101200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101200000XBehavioral Health & Social Service ProvidersDrama Therapist