Provider Demographics
NPI:1225254303
Name:RICHARDSON, AMELDA (AMY) J (MED, MA)
Entity Type:Individual
Prefix:MS
First Name:AMELDA (AMY)
Middle Name:J
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:MED, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2012 E ST
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301-4223
Mailing Address - Country:US
Mailing Address - Phone:661-328-1465
Mailing Address - Fax:
Practice Address - Street 1:2012 E ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-4223
Practice Address - Country:US
Practice Address - Phone:661-328-1465
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 31043106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist