Provider Demographics
NPI:1669594107
Name:RICHARDS, MARIE B (MSSW, LCSW)
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:B
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:MSSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4280 WINDSONG PL
Mailing Address - Street 2:
Mailing Address - City:PLOVER
Mailing Address - State:WI
Mailing Address - Zip Code:54467-9018
Mailing Address - Country:US
Mailing Address - Phone:608-698-9452
Mailing Address - Fax:
Practice Address - Street 1:1547 STRONGS AVE STE D
Practice Address - Street 2:
Practice Address - City:STEVENS POINT
Practice Address - State:WI
Practice Address - Zip Code:54481-3566
Practice Address - Country:US
Practice Address - Phone:715-303-2900
Practice Address - Fax:715-303-2928
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI69971231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40993500Medicaid