Provider Demographics
NPI:1689765208
Name:RICHMOND, DAVIS L (LICSW)
Entity Type:Individual
Prefix:MR
First Name:DAVIS
Middle Name:L
Last Name:RICHMOND
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 HANOVER ST
Mailing Address - Street 2:PO BOX 448
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03101-2203
Mailing Address - Country:US
Mailing Address - Phone:603-668-1920
Mailing Address - Fax:603-668-6260
Practice Address - Street 1:99 HANOVER ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03101-2203
Practice Address - Country:US
Practice Address - Phone:603-668-1920
Practice Address - Fax:603-668-6260
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH12331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30423291Medicaid