Provider Demographics
NPI:1356489058
Name:AVERY, RICHARD F (LCSW)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:F
Last Name:AVERY
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3011
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92163-1011
Mailing Address - Country:US
Mailing Address - Phone:858-535-1836
Mailing Address - Fax:858-457-1416
Practice Address - Street 1:5230 CARROLL CANYON RD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-1778
Practice Address - Country:US
Practice Address - Phone:858-535-1836
Practice Address - Fax:858-457-1416
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS38831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASW3883Medicare ID - Type UnspecifiedSOCIAL WORKER