Provider Demographics
NPI:1326856337
Name:RICHARDSON, CYNTHIA LAVERNE
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:LAVERNE
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 AVA AVE
Mailing Address - Street 2:
Mailing Address - City:SOMERDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:08083-1602
Mailing Address - Country:US
Mailing Address - Phone:856-793-8000
Mailing Address - Fax:
Practice Address - Street 1:200 AVA AVE
Practice Address - Street 2:
Practice Address - City:SOMERDALE
Practice Address - State:NJ
Practice Address - Zip Code:08083-1602
Practice Address - Country:US
Practice Address - Phone:856-793-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-23
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ172A00000X
376J00000X, 372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion
No172A00000XOther Service ProvidersDriver
No376J00000XNursing Service Related ProvidersHomemaker