Provider Demographics
NPI:1255062667
Name:RICHEY, ANDREW (LCSW)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:RICHEY
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1804 COUNTY ROAD II
Mailing Address - Street 2:
Mailing Address - City:NEENAH
Mailing Address - State:WI
Mailing Address - Zip Code:54956-1841
Mailing Address - Country:US
Mailing Address - Phone:727-674-8033
Mailing Address - Fax:
Practice Address - Street 1:2138 CHIANTI PL
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34683-7747
Practice Address - Country:US
Practice Address - Phone:727-674-8033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-17
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL199551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty