Provider Demographics
NPI:1871005678
Name:JACKSON-DELOACH, RICHEA ONEA (LSW)
Entity Type:Individual
Prefix:
First Name:RICHEA
Middle Name:ONEA
Last Name:JACKSON-DELOACH
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2257 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01107-1905
Mailing Address - Country:US
Mailing Address - Phone:413-733-3488
Mailing Address - Fax:413-732-5856
Practice Address - Street 1:2257 MAIN ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01107-1905
Practice Address - Country:US
Practice Address - Phone:413-733-3488
Practice Address - Fax:413-732-5856
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-02
Last Update Date:2017-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker