Provider Demographics
NPI:1942367735
Name:RICHARDSON, ROBIN J (QMHP)
Entity Type:Individual
Prefix:MS
First Name:ROBIN
Middle Name:J
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 ESTRELLA DR
Mailing Address - Street 2:
Mailing Address - City:ROHNERT PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94928-2308
Mailing Address - Country:US
Mailing Address - Phone:707-585-2148
Mailing Address - Fax:
Practice Address - Street 1:1333 7TH ST
Practice Address - Street 2:
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94945-1801
Practice Address - Country:US
Practice Address - Phone:415-897-7195
Practice Address - Fax:415-897-9687
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health