Provider Demographics
NPI:1972366417
Name:RICHARDS, DEVONTE (LSW)
Entity Type:Individual
Prefix:
First Name:DEVONTE
Middle Name:
Last Name:RICHARDS
Suffix:
Gender:M
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 TRPISOVSKY CT
Mailing Address - Street 2:
Mailing Address - City:PARLIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08859-3147
Mailing Address - Country:US
Mailing Address - Phone:973-955-3154
Mailing Address - Fax:
Practice Address - Street 1:499 PLAINFIELD AVE
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08817-2592
Practice Address - Country:US
Practice Address - Phone:732-985-5300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-06
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL06555900104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker