Provider Demographics
NPI:1851607139
Name:RICHARDSON, RHODA JEAN (LCSW)
Entity Type:Individual
Prefix:
First Name:RHODA
Middle Name:JEAN
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 1:25 ROTARY DR
Mailing Address - Street 2:
Mailing Address - City:SACO
Mailing Address - State:ME
Mailing Address - Zip Code:04072-9500
Mailing Address - Country:US
Mailing Address - Phone:207-282-0695
Mailing Address - Fax:
Practice Address - Street 1:25 ROTARY DR
Practice Address - Street 2:
Practice Address - City:SACO
Practice Address - State:ME
Practice Address - Zip Code:04072-9500
Practice Address - Country:US
Practice Address - Phone:207-282-0695
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-25
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC106511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME433327099OtherPROVIDER ENROLLMENT
ME433327099OtherPROVIDER ENROLLMENT