Provider Demographics
NPI:1144392101
Name:RICHARDSON, DONNA L (MSW LCSW LCADC)
Entity Type:Individual
Prefix:MS
First Name:DONNA
Middle Name:L
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:MSW LCSW LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:CALIFON
Mailing Address - State:NJ
Mailing Address - Zip Code:07830
Mailing Address - Country:US
Mailing Address - Phone:908-832-2812
Mailing Address - Fax:908-832-5071
Practice Address - Street 1:18 MAIN STREET
Practice Address - Street 2:
Practice Address - City:CALIFON
Practice Address - State:NJ
Practice Address - Zip Code:07830
Practice Address - Country:US
Practice Address - Phone:908-832-2812
Practice Address - Fax:908-832-5071
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC001482001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ802461AHEMedicare PIN