Provider Demographics
NPI:1366015026
Name:RICHARDSON, SYMONE MONIQUE
Entity Type:Individual
Prefix:
First Name:SYMONE
Middle Name:MONIQUE
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 SPINDRIFT DR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-7807
Mailing Address - Country:US
Mailing Address - Phone:716-574-6036
Mailing Address - Fax:716-817-2602
Practice Address - Street 1:280 SPINDRIFT DR
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-7807
Practice Address - Country:US
Practice Address - Phone:716-574-6036
Practice Address - Fax:716-817-2602
Is Sole Proprietor?:No
Enumeration Date:2021-07-21
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator