Provider Demographics
NPI:1285635185
Name:RICHARD, ROSEMARY EILEEN (ACSW, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ROSEMARY
Middle Name:EILEEN
Last Name:RICHARD
Suffix:
Gender:F
Credentials:ACSW, LCSW
Other - Prefix:MISS
Other - First Name:ROSEMARY
Other - Middle Name:
Other - Last Name:ZIMMERER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:2214 AVALON CT
Mailing Address - Street 2:
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46902-3102
Mailing Address - Country:US
Mailing Address - Phone:765-453-6423
Mailing Address - Fax:
Practice Address - Street 1:618 S MAIN ST
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46901-5462
Practice Address - Country:US
Practice Address - Phone:765-457-9313
Practice Address - Fax:765-868-4122
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2009-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN101YM0800X, 101YP2500X, 106H00000X
IN34001663A104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100136000AMedicaid
IN292869000OtherMAGELLAN
IN000000204132OtherANTHEM BC/BS
IN365610AMedicare ID - Type UnspecifiedFAMILY SERVICE ASSOCIATIO