Provider Demographics
NPI:1134799364
Name:RICHARDS, CLARENE LAVERNE
Entity type:Individual
Prefix:
First Name:CLARENE
Middle Name:LAVERNE
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7937 SEAVIEW AVE # D2
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-4144
Mailing Address - Country:US
Mailing Address - Phone:347-628-1228
Mailing Address - Fax:
Practice Address - Street 1:7937 SEAVIEW AVE # D2
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236-4144
Practice Address - Country:US
Practice Address - Phone:347-628-1228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-29
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0794981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical