Provider Demographics
NPI:1356448898
Name:RICHNER, TIMOTHY D
Entity type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:D
Last Name:RICHNER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1315 WINDRIM AVENUE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19141-2710
Mailing Address - Country:US
Mailing Address - Phone:215-456-3900
Mailing Address - Fax:215-456-2729
Practice Address - Street 1:1315 WINDRIM AVENUE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19141-2710
Practice Address - Country:US
Practice Address - Phone:215-456-3900
Practice Address - Fax:215-456-2729
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0135921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAQ31436Medicare UPIN