Provider Demographics
NPI:1326553363
Name:RICHARDS, REBECCA (MSW)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2659 COUNTY ROAD 350 E
Mailing Address - Street 2:
Mailing Address - City:MAHOMET
Mailing Address - State:IL
Mailing Address - Zip Code:61853-9797
Mailing Address - Country:US
Mailing Address - Phone:217-372-4157
Mailing Address - Fax:
Practice Address - Street 1:2659 COUNTY ROAD 350 E
Practice Address - Street 2:
Practice Address - City:MAHOMET
Practice Address - State:IL
Practice Address - Zip Code:61853-9797
Practice Address - Country:US
Practice Address - Phone:217-372-4157
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-13
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.1028801041C0700X
IL150102880104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical