Provider Demographics
NPI:1356407712
Name:WARE, RICHARD MARTIN (LCSW)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:MARTIN
Last Name:WARE
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 1:316 ROUTE 152
Mailing Address - Street 2:
Mailing Address - City:PERKASIE
Mailing Address - State:PA
Mailing Address - Zip Code:18944-2627
Mailing Address - Country:US
Mailing Address - Phone:215-258-3853
Mailing Address - Fax:215-258-3973
Practice Address - Street 1:316 ROUTE 152
Practice Address - Street 2:
Practice Address - City:PERKASIE
Practice Address - State:PA
Practice Address - Zip Code:18944-2627
Practice Address - Country:US
Practice Address - Phone:215-258-3853
Practice Address - Fax:215-258-3973
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0124641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
R07137OtherKEYSTONE 65
PA236334Medicaid
0682444000OtherPERSONAL CHOICE
5321519OtherAETNA
0682444000OtherPERSONAL CHOICE