Provider Demographics
NPI:1083309231
Name:RICHARDSON, ESTELLE JACQUELINE (LICSW)
Entity Type:Individual
Prefix:MS
First Name:ESTELLE
Middle Name:JACQUELINE
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 BROCKTON RD
Mailing Address - Street 2:
Mailing Address - City:OXON HILL
Mailing Address - State:MD
Mailing Address - Zip Code:20745-1516
Mailing Address - Country:US
Mailing Address - Phone:240-461-3927
Mailing Address - Fax:
Practice Address - Street 1:301 BROCKTON RD
Practice Address - Street 2:
Practice Address - City:OXON HILL
Practice Address - State:MD
Practice Address - Zip Code:20745-1516
Practice Address - Country:US
Practice Address - Phone:240-461-3927
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-05
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC3010011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical