Provider Demographics
NPI:1679951313
Name:RICHARDS, CARLEEN CHARMAINE
Entity Type:Individual
Prefix:
First Name:CARLEEN
Middle Name:CHARMAINE
Last Name:RICHARDS
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 1:120 ALDRICH ST APT 23G
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10475-4504
Mailing Address - Country:US
Mailing Address - Phone:646-836-3633
Mailing Address - Fax:
Practice Address - Street 1:120 ALDRICH ST
Practice Address - Street 2:23G
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10475-4504
Practice Address - Country:US
Practice Address - Phone:646-836-3633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-14
Last Update Date:2015-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist