Provider Demographics
NPI:1972819910
Name:RICHARDSON, ROBERT HARRY (LMSW)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:HARRY
Last Name:RICHARDSON
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 FIRE ROAD DR
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-3947
Mailing Address - Country:US
Mailing Address - Phone:631-666-1951
Mailing Address - Fax:631-593-5472
Practice Address - Street 1:269 W MAIN ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-8319
Practice Address - Country:US
Practice Address - Phone:631-666-1951
Practice Address - Fax:631-593-5472
Is Sole Proprietor?:No
Enumeration Date:2010-08-27
Last Update Date:2013-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY077972104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker