Provider Demographics
NPI:1689664450
Name:RICHARDSON, LINDA LEE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:LEE
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9391 TILLES DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63144-1013
Mailing Address - Country:US
Mailing Address - Phone:314-968-8585
Mailing Address - Fax:314-968-3655
Practice Address - Street 1:1000 LAKE SAINT LOUIS BLVD
Practice Address - Street 2:SUITE 217
Practice Address - City:LAKE SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63367-1340
Practice Address - Country:US
Practice Address - Phone:314-968-8585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOSW0045851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical