Provider Demographics
NPI:1861622110
Name:PATRICIA RICHARDSON MSW, LICSW, LMFT, LTD
Entity type:Organization
Organization Name:PATRICIA RICHARDSON MSW, LICSW, LMFT, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LICSW, LMFT
Authorized Official - Phone:507-645-5644
Mailing Address - Street 1:401 DIVISION ST S STE C
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55057-2096
Mailing Address - Country:US
Mailing Address - Phone:507-645-5644
Mailing Address - Fax:507-645-9291
Practice Address - Street 1:401 DIVISION ST S STE C
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55057-2096
Practice Address - Country:US
Practice Address - Phone:507-645-5644
Practice Address - Fax:507-645-9291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-21
Last Update Date:2010-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNC05330Medicare PIN