Provider Demographics
NPI:1407948086
Name:RICHARDSON, GARY ALAN (ACSW MSW LSW)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:ALAN
Last Name:RICHARDSON
Suffix:
Gender:M
Credentials:ACSW MSW LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:874 GREYTON RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44112
Mailing Address - Country:US
Mailing Address - Phone:216-851-7033
Mailing Address - Fax:216-851-1329
Practice Address - Street 1:3210 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44115
Practice Address - Country:US
Practice Address - Phone:216-621-0766
Practice Address - Fax:216-622-7788
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS00301871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHS0030187OtherSOCIAL WORK BOARD