Provider Demographics
NPI:1043701923
Name:RICHARDSON, ALEXANDRA DINGMAN
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:DINGMAN
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 OLD BAY RD
Mailing Address - Street 2:
Mailing Address - City:BOLTON
Mailing Address - State:MA
Mailing Address - Zip Code:01740-1344
Mailing Address - Country:US
Mailing Address - Phone:617-823-5271
Mailing Address - Fax:
Practice Address - Street 1:53 OLD BAY RD
Practice Address - Street 2:
Practice Address - City:BOLTON
Practice Address - State:MA
Practice Address - Zip Code:01740-1344
Practice Address - Country:US
Practice Address - Phone:617-823-5271
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-25
Last Update Date:2018-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist