Provider Demographics
NPI:1316024110
Name:RICHARDSON, EMILY D (PHD)
Entity Type:Individual
Prefix:DR
First Name:EMILY
Middle Name:D
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 CREEKSIDE DRIVE
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80504-7795
Mailing Address - Country:US
Mailing Address - Phone:303-735-1130
Mailing Address - Fax:303-492-2967
Practice Address - Street 1:345 UCB
Practice Address - Street 2:MUENZINGER D232A
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80309-0345
Practice Address - Country:US
Practice Address - Phone:303-735-1130
Practice Address - Fax:303-492-2967
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2020-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2351103T00000X, 103TC0700X, 103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC93146Medicare PIN
COR86194Medicare UPIN