Provider Demographics
NPI:1952705030
Name:RICHMOND, KEITH
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:
Last Name:RICHMOND
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1970 VETERANS HWY
Mailing Address - Street 2:
Mailing Address - City:LEVITTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19056-2518
Mailing Address - Country:US
Mailing Address - Phone:267-697-9671
Mailing Address - Fax:
Practice Address - Street 1:1970 VETERANS HWY
Practice Address - Street 2:
Practice Address - City:LEVITTOWN
Practice Address - State:PA
Practice Address - Zip Code:19056-2518
Practice Address - Country:US
Practice Address - Phone:267-697-9671
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-17
Last Update Date:2014-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health