Provider Demographics
NPI:1740048602
Name:RICHARDSON, BRIANNA SHAUNTE
Entity type:Individual
Prefix:
First Name:BRIANNA
Middle Name:SHAUNTE
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 1:12036 ALBERTA DR
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19154-2701
Mailing Address - Country:US
Mailing Address - Phone:267-269-3904
Mailing Address - Fax:
Practice Address - Street 1:970 TOWN CENTER DRIVE
Practice Address - Street 2:SUITE C-100
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047
Practice Address - Country:US
Practice Address - Phone:267-609-3995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-06
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician