Provider Demographics
NPI:1427183524
Name:RICHARD, GEORGANN M (LCSW)
Entity Type:Individual
Prefix:
First Name:GEORGANN
Middle Name:M
Last Name:RICHARD
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 1:3939 W RIDGE RD
Mailing Address - Street 2:SUITE B50
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16506-1879
Mailing Address - Country:US
Mailing Address - Phone:814-868-2600
Mailing Address - Fax:814-838-7743
Practice Address - Street 1:3939 W RIDGE RD
Practice Address - Street 2:SUITE B50
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16506-1879
Practice Address - Country:US
Practice Address - Phone:814-868-2600
Practice Address - Fax:814-838-7743
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW012922101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA644716Medicare UPIN