Provider Demographics
NPI:1508364910
Name:MILLS, RICHARD MATTHEW (EDD, LCSW, CST, CH)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:MATTHEW
Last Name:MILLS
Suffix:
Gender:M
Credentials:EDD, LCSW, CST, CH
Other - Prefix:MR
Other - First Name:RICHARD
Other - Middle Name:MATTHEW
Other - Last Name:MILLS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:EDD, LCSW, CHT
Mailing Address - Street 1:250 W 50TH ST APT 24K
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-6725
Mailing Address - Country:US
Mailing Address - Phone:929-302-1400
Mailing Address - Fax:
Practice Address - Street 1:250 W 50TH ST APT 24K
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-6725
Practice Address - Country:US
Practice Address - Phone:929-302-1400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-31
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0910391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical