Provider Demographics
NPI:1477626539
Name:POPSON, RICHARD (LCSW)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:POPSON
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 1:40 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14075-4905
Mailing Address - Country:US
Mailing Address - Phone:716-648-5262
Mailing Address - Fax:716-648-1033
Practice Address - Street 1:40 MAIN ST
Practice Address - Street 2:
Practice Address - City:HAMBURG
Practice Address - State:NY
Practice Address - Zip Code:14075-4905
Practice Address - Country:US
Practice Address - Phone:716-648-5262
Practice Address - Fax:716-648-1033
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028838104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01967871Medicaid
NY00671807Medicaid
NY043061Medicare ID - Type Unspecified
NY00671807Medicaid