Provider Demographics
NPI:1982168407
Name:RICHARDSON PSYCHIATRIC
Entity Type:Organization
Organization Name:RICHARDSON PSYCHIATRIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:D
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:773-732-6427
Mailing Address - Street 1:5000 S EAST END AVE APT 8B
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60615-3173
Mailing Address - Country:US
Mailing Address - Phone:773-732-6427
Mailing Address - Fax:
Practice Address - Street 1:3660 N LAKE SHORE DR STE 201
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-5302
Practice Address - Country:US
Practice Address - Phone:773-599-9246
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-29
Last Update Date:2019-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1144639527OtherBLUE CROSS BLUE SHIELD
1144639527OtherCIGNA
1144639527OtherAETNA