Provider Demographics
NPI:1043223589
Name:RICHE, MARY M (MSW)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:M
Last Name:RICHE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 28TH ST
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50312-4406
Mailing Address - Country:US
Mailing Address - Phone:515-288-4448
Mailing Address - Fax:
Practice Address - Street 1:1922 INGERSOLL AVE
Practice Address - Street 2:SUITE 118
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-3339
Practice Address - Country:US
Practice Address - Phone:515-282-7699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA12021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical