Provider Demographics
NPI:1578702759
Name:RICHARDSON, MAURY
Entity Type:Individual
Prefix:MR
First Name:MAURY
Middle Name:
Last Name:RICHARDSON
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 1:2217 ARTESIA BLVD
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90504-2945
Mailing Address - Country:US
Mailing Address - Phone:562-929-6688
Mailing Address - Fax:562-929-3868
Practice Address - Street 1:12440 FIRESTONE BLVD
Practice Address - Street 2:SUITE 3025
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650
Practice Address - Country:US
Practice Address - Phone:562-929-6688
Practice Address - Fax:562-929-3868
Is Sole Proprietor?:No
Enumeration Date:2009-02-12
Last Update Date:2010-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1669560488Medicaid