Provider Demographics
NPI:1194747360
Name:RICHARDSON, LEROY (PSY D)
Entity type:Individual
Prefix:
First Name:LEROY
Middle Name:
Last Name:RICHARDSON
Suffix:
Gender:M
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 BEACON PKWY W
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209-3139
Mailing Address - Country:US
Mailing Address - Phone:205-943-5588
Mailing Address - Fax:205-943-5614
Practice Address - Street 1:201 BEACON PKWY W
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209-3139
Practice Address - Country:US
Practice Address - Phone:205-943-5588
Practice Address - Fax:205-943-5614
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL932103TC0700X
GAPSY002675103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALP13682Medicare UPIN