Provider Demographics
NPI:1467493098
Name:WILLHITE, RICHARD HOWARD (LICSW)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:HOWARD
Last Name:WILLHITE
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81 CLARK AVE
Mailing Address - Street 2:
Mailing Address - City:BRATTLEBORO
Mailing Address - State:VT
Mailing Address - Zip Code:05301-6434
Mailing Address - Country:US
Mailing Address - Phone:413-768-9326
Mailing Address - Fax:413-773-9301
Practice Address - Street 1:25 BANK ROW ST
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:MA
Practice Address - Zip Code:01301-3599
Practice Address - Country:US
Practice Address - Phone:413-768-9326
Practice Address - Fax:413-773-9301
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2015-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1116891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP23582Medicare ID - Type Unspecified