Provider Demographics
NPI:1952541872
Name:RICHARDSON, CARMELA ALTAMSES (LLMSW,LPN)
Entity Type:Individual
Prefix:MRS
First Name:CARMELA
Middle Name:ALTAMSES
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:LLMSW,LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 CONNER ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48215-2407
Mailing Address - Country:US
Mailing Address - Phone:313-308-1400
Mailing Address - Fax:313-308-1600
Practice Address - Street 1:25127 LINDENWOOD LN
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48033-6189
Practice Address - Country:US
Practice Address - Phone:216-215-8522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-05
Last Update Date:2014-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703112909164W00000X
MI68010948811041C0700X
OHS.0701223104100000X
OHPN.091680164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No164W00000XNursing Service ProvidersLicensed Practical Nurse
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical