Provider Demographics
NPI:1437764933
Name:RICHBURG, ELIZABETH (MS, MA)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:RICHBURG
Suffix:
Gender:F
Credentials:MS, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5709 W JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19131-3417
Mailing Address - Country:US
Mailing Address - Phone:267-603-2631
Mailing Address - Fax:
Practice Address - Street 1:5709 W JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19131-3417
Practice Address - Country:US
Practice Address - Phone:267-603-2631
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-11
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor