Provider Demographics
NPI:1326169426
Name:RICHARDSON, SUSAN GREENBERG (LCPC)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:GREENBERG
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:149 YOUNGS HILL ROAD
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:ME
Mailing Address - Zip Code:04574-0316
Mailing Address - Country:US
Mailing Address - Phone:207-845-2807
Mailing Address - Fax:
Practice Address - Street 1:255 MOLYNEAUX RD
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:ME
Practice Address - Zip Code:04843-4127
Practice Address - Country:US
Practice Address - Phone:207-236-2884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC 930101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health