Provider Demographics
NPI:1245248434
Name:RICHARDSON, GORDON (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:GORDON
Middle Name:
Last Name:RICHARDSON
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9343 TECH CENTER DR FL 2
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95826-2563
Mailing Address - Country:US
Mailing Address - Phone:916-388-6301
Mailing Address - Fax:866-680-0843
Practice Address - Street 1:9343 TECH CENTER DR FL 2
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95826-2563
Practice Address - Country:US
Practice Address - Phone:916-388-6301
Practice Address - Fax:866-680-0843
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW 238951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical