Provider Demographics
NPI:1235222555
Name:RICHARDSON, KATHERINE (LCSW-C)
Entity Type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 ELM AVE
Mailing Address - Street 2:
Mailing Address - City:TAKOMA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20912-5437
Mailing Address - Country:US
Mailing Address - Phone:301-891-2540
Mailing Address - Fax:
Practice Address - Street 1:1015 SPRING ST STE 201
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-4012
Practice Address - Country:US
Practice Address - Phone:301-588-4183
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD065581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDRI033811Medicare ID - Type Unspecified