Provider Demographics
NPI:1841492360
Name:RICHARDS, MARK A (MSW)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:A
Last Name:RICHARDS
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 LYMAN RD
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01011-9684
Mailing Address - Country:US
Mailing Address - Phone:413-563-3157
Mailing Address - Fax:
Practice Address - Street 1:19 LYMAN RD
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:MA
Practice Address - Zip Code:01011-9684
Practice Address - Country:US
Practice Address - Phone:413-563-3157
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10179731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical