Provider Demographics
NPI:1376005587
Name:RICHARDS, JONICA LEIGH (MSGC)
Entity Type:Individual
Prefix:
First Name:JONICA
Middle Name:LEIGH
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:MSGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:158 CHERRY ST APT 3H
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-3454
Mailing Address - Country:US
Mailing Address - Phone:715-581-8383
Mailing Address - Fax:
Practice Address - Street 1:330 ORCHARD ST STE 107&109
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-4417
Practice Address - Country:US
Practice Address - Phone:203-200-4362
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-05
Last Update Date:2019-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT246170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS