Provider Demographics
NPI:1255656591
Name:UNDERWOOD, RICHARD C (LMSW)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:C
Last Name:UNDERWOOD
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 NORTH PARK STREET, 2ND FLOOR
Mailing Address - Street 2:
Mailing Address - City:SENECA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:13148-1437
Mailing Address - Country:US
Mailing Address - Phone:315-568-9412
Mailing Address - Fax:315-568-6718
Practice Address - Street 1:12 NORTH PARK STREET, 2ND FLOOR
Practice Address - Street 2:
Practice Address - City:SENECA FALLS
Practice Address - State:NY
Practice Address - Zip Code:13148-1437
Practice Address - Country:US
Practice Address - Phone:315-568-9412
Practice Address - Fax:315-568-6718
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-30
Last Update Date:2010-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044263-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker