Provider Demographics
NPI:1386964963
Name:RICHARDS, MARIA C (PSYD)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:C
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:676 WYOMING AVE
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18704-3857
Mailing Address - Country:US
Mailing Address - Phone:570-283-1600
Mailing Address - Fax:570-283-5515
Practice Address - Street 1:676 WYOMING AVE
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:PA
Practice Address - Zip Code:18704-3857
Practice Address - Country:US
Practice Address - Phone:570-283-1600
Practice Address - Fax:570-283-5515
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-07
Last Update Date:2010-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS015302103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical