Provider Demographics
NPI:1306464516
Name:RICHARDS, BRIDGET DEVOTA (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:BRIDGET
Middle Name:DEVOTA
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:BRIDGET
Other - Middle Name:DEVOTA
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:119 TOWER VIEW LN
Mailing Address - Street 2:
Mailing Address - City:OZARK
Mailing Address - State:MO
Mailing Address - Zip Code:65721-7144
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:119 TOWER VIEW LN
Practice Address - Street 2:
Practice Address - City:OZARK
Practice Address - State:MO
Practice Address - Zip Code:65721-7144
Practice Address - Country:US
Practice Address - Phone:712-213-0109
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-14
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA099966104100000X
MO20200257911041C0700X
MO20230006311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker