Provider Demographics
NPI:1285051201
Name:RICHARDS, MARY A (RN, BS, CCM)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:A
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:RN, BS, CCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 NANNIE ST
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15301-9735
Mailing Address - Country:US
Mailing Address - Phone:724-627-1951
Mailing Address - Fax:724-627-1670
Practice Address - Street 1:220 GREENE PLZ
Practice Address - Street 2:
Practice Address - City:WAYNESBURG
Practice Address - State:PA
Practice Address - Zip Code:15370-8144
Practice Address - Country:US
Practice Address - Phone:724-627-1951
Practice Address - Fax:724-627-1670
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-27
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN184303L171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator