Provider Demographics
NPI:1689263808
Name:RICHARDSON, CARELL (LSW)
Entity Type:Individual
Prefix:
First Name:CARELL
Middle Name:
Last Name:RICHARDSON
Suffix:
Gender:M
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 KIRBY LN
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08823-1334
Mailing Address - Country:US
Mailing Address - Phone:862-253-9251
Mailing Address - Fax:
Practice Address - Street 1:7 KIRBY LN
Practice Address - Street 2:
Practice Address - City:FRANKLIN PARK
Practice Address - State:NJ
Practice Address - Zip Code:08823-1334
Practice Address - Country:US
Practice Address - Phone:862-253-9251
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-12
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL06550700104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker