Provider Demographics
NPI:1891801304
Name:RICHARD, PAUL V (LCSW-C)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:V
Last Name:RICHARD
Suffix:
Gender:M
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 643
Mailing Address - Street 2:
Mailing Address - City:SOLOMONS
Mailing Address - State:MD
Mailing Address - Zip Code:20688-0643
Mailing Address - Country:US
Mailing Address - Phone:410-326-4933
Mailing Address - Fax:
Practice Address - Street 1:41900 FENWICK ST
Practice Address - Street 2:SUITE 1
Practice Address - City:LEONARDTOWN
Practice Address - State:MD
Practice Address - Zip Code:20650-3813
Practice Address - Country:US
Practice Address - Phone:301-475-9660
Practice Address - Fax:301-475-8810
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04310104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD620828OtherMDIPA
MD620828OtherGEHA
MD620828OtherOPTIMUM CHOICE
MDB950 0003OtherCAREFIRST BCBS FEP & NCA
MD620828OtherALLIANCE
MD293611000OtherMAGELLAN
MD517B 54808903OtherCAREFIRST BCBS
MD620828OtherMAMSI
MDPVPB114921OtherAPS
MD620828OtherALLIANCE
MD182NMedicare PIN