Provider Demographics
NPI:1457805913
Name:RICHARDSON, CARLOTTA
Entity Type:Individual
Prefix:
First Name:CARLOTTA
Middle Name:
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1052 WASHINGTON ST
Mailing Address - Street 2:APT.3
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02124-5533
Mailing Address - Country:US
Mailing Address - Phone:857-249-3528
Mailing Address - Fax:
Practice Address - Street 1:1052 WASHINGTON ST
Practice Address - Street 2:APT.3
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02124-5533
Practice Address - Country:US
Practice Address - Phone:857-249-3528
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-12
Last Update Date:2016-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst