Provider Demographics
NPI:1346780764
Name:RICHARDSON, DENISE (LMHC, CASAC)
Entity Type:Individual
Prefix:MS
First Name:DENISE
Middle Name:
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:LMHC, CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8400 SHORE FRONT PKWY APT 8C
Mailing Address - Street 2:
Mailing Address - City:ROCKAWAY BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11693-1816
Mailing Address - Country:US
Mailing Address - Phone:646-436-6481
Mailing Address - Fax:718-945-2149
Practice Address - Street 1:8400 SHORE FRONT PKWY APT 8C
Practice Address - Street 2:
Practice Address - City:ROCKAWAY BEACH
Practice Address - State:NY
Practice Address - Zip Code:11693-1816
Practice Address - Country:US
Practice Address - Phone:646-436-6481
Practice Address - Fax:718-945-2149
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-03
Last Update Date:2017-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY18351101YA0400X
NY007158-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)