Provider Demographics
NPI:1831334127
Name:RICHARDSON, GRETCHEN ELIZABETH (LCSW)
Entity type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:ELIZABETH
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:342 GRIEB RD
Mailing Address - Street 2:
Mailing Address - City:WALLINGFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06492-2512
Mailing Address - Country:US
Mailing Address - Phone:203-640-0178
Mailing Address - Fax:203-793-7152
Practice Address - Street 1:342 GRIEB RD
Practice Address - Street 2:
Practice Address - City:WALLINGFORD
Practice Address - State:CT
Practice Address - Zip Code:06492-2512
Practice Address - Country:US
Practice Address - Phone:203-640-0178
Practice Address - Fax:203-793-7152
Is Sole Proprietor?:No
Enumeration Date:2008-12-16
Last Update Date:2019-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT006456101YM0800X, 101YA0400X, 104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker