Provider Demographics
NPI:1265446637
Name:RICHARDSON, DEBRA DIANE (LCSW)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:DIANE
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:DEBRA
Other - Middle Name:
Other - Last Name:HARPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:901 E 104TH STREET
Mailing Address - Street 2:MAILSTOP 400S
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64131
Mailing Address - Country:US
Mailing Address - Phone:816-502-7117
Mailing Address - Fax:816-932-9670
Practice Address - Street 1:8880 NE 82ND TER
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64158-1313
Practice Address - Country:US
Practice Address - Phone:816-932-1711
Practice Address - Fax:816-932-1719
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0060671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO006067OtherLCSW