Provider Demographics
NPI:1568814457
Name:RICHEY, BRENDON
Entity Type:Individual
Prefix:MR
First Name:BRENDON
Middle Name:
Last Name:RICHEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3435 SUPERIOR PARK DR
Mailing Address - Street 2:APT 202
Mailing Address - City:CLEVELAND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44118-2146
Mailing Address - Country:US
Mailing Address - Phone:513-544-7547
Mailing Address - Fax:
Practice Address - Street 1:3435 SUPERIOR PARK DR
Practice Address - Street 2:APT 202
Practice Address - City:CLEVELAND HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44118-2146
Practice Address - Country:US
Practice Address - Phone:513-544-7547
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-05
Last Update Date:2016-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker