Provider Demographics
NPI:1710750690
Name:DRESDALE, RICHARD CONRAD JR (LCSW)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:CONRAD
Last Name:DRESDALE
Suffix:JR
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:494 BOSTON POST RD APT C219
Mailing Address - Street 2:
Mailing Address - City:WAYLAND
Mailing Address - State:MA
Mailing Address - Zip Code:01778-1870
Mailing Address - Country:US
Mailing Address - Phone:914-384-5602
Mailing Address - Fax:
Practice Address - Street 1:494 BOSTON POST RD APT C219
Practice Address - Street 2:
Practice Address - City:WAYLAND
Practice Address - State:MA
Practice Address - Zip Code:01778-1870
Practice Address - Country:US
Practice Address - Phone:914-384-5602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-02
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2300391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty