Provider Demographics
NPI:1720790199
Name:RICHARDS, JONATHAN MICHAEL (MHC INTERN)
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:MICHAEL
Last Name:RICHARDS
Suffix:
Gender:M
Credentials:MHC INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:661 WOODWARD AVE APT 1L
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11385-2214
Mailing Address - Country:US
Mailing Address - Phone:847-504-6534
Mailing Address - Fax:
Practice Address - Street 1:661 WOODWARD AVE APT 1L
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NY
Practice Address - Zip Code:11385-2214
Practice Address - Country:US
Practice Address - Phone:847-504-6534
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-16
Last Update Date:2022-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor