Provider Demographics
NPI:1407879968
Name:RICHARDS, SUSAN C (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:C
Last Name:RICHARDS
Suffix:
Gender:F
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 3154
Mailing Address - Street 2:
Mailing Address - City:DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92014-6154
Mailing Address - Country:US
Mailing Address - Phone:858-481-1237
Mailing Address - Fax:
Practice Address - Street 1:224 BIRMINGHAM DR
Practice Address - Street 2:SUITE 1A1
Practice Address - City:CARDIFF BY THE SEA
Practice Address - State:CA
Practice Address - Zip Code:92007-1758
Practice Address - Country:US
Practice Address - Phone:858-481-1237
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2010-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 67941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASW 6794Medicare ID - Type Unspecified