Provider Demographics
NPI:1598024366
Name:RICHARDSON, EVA
Entity Type:Individual
Prefix:
First Name:EVA
Middle Name:
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 WAVERLYOAKSRD
Mailing Address - Street 2:BLDG. 3, SUITE 305THOM CHARLES RIVER EARLY INTERVENTION
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02452
Mailing Address - Country:US
Mailing Address - Phone:781-894-6564
Mailing Address - Fax:
Practice Address - Street 1:411 WAVERLEY OAKS RD
Practice Address - Street 2:BLDG. 3, SUITE 305 THOMCHARLESRIVER EARLYINTERVENTION
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02452
Practice Address - Country:US
Practice Address - Phone:781-894-6564
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-14
Last Update Date:2012-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist