Provider Demographics
NPI:1295513513
Name:RICHARDSON, AMBER L (MSW, LSW)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:L
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 N LOGAN AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:61832-5613
Mailing Address - Country:US
Mailing Address - Phone:217-442-3200
Mailing Address - Fax:217-431-1779
Practice Address - Street 1:309 N LOGAN AVE
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IL
Practice Address - Zip Code:61832-5613
Practice Address - Country:US
Practice Address - Phone:217-442-3200
Practice Address - Fax:217-431-1779
Is Sole Proprietor?:No
Enumeration Date:2023-09-18
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150111530104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker