Provider Demographics
NPI:1518318468
Name:RICHARDS, JEROLYN DALORES
Entity Type:Individual
Prefix:MS
First Name:JEROLYN
Middle Name:DALORES
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:JEROLYN
Other - Middle Name:DALORES
Other - Last Name:RICHARDS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS ED
Mailing Address - Street 1:14231 249TH ST
Mailing Address - Street 2:
Mailing Address - City:ROSEDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11422-2143
Mailing Address - Country:US
Mailing Address - Phone:347-303-9744
Mailing Address - Fax:
Practice Address - Street 1:14231 249TH ST
Practice Address - Street 2:
Practice Address - City:ROSEDALE
Practice Address - State:NY
Practice Address - Zip Code:11422-2143
Practice Address - Country:US
Practice Address - Phone:347-303-9744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-22
Last Update Date:2016-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst