Provider Demographics
NPI:1528666161
Name:RICHARDSON, JENICE NICOLETTE (SPECIAL EDUCATOR)
Entity type:Individual
Prefix:MRS
First Name:JENICE
Middle Name:NICOLETTE
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:SPECIAL EDUCATOR
Other - Prefix:MS
Other - First Name:JENICE
Other - Middle Name:NICOLETTE
Other - Last Name:GILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SPECIAL EDUCATOR
Mailing Address - Street 1:33 ELIZABETH ST
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10310-1933
Mailing Address - Country:US
Mailing Address - Phone:646-567-8635
Mailing Address - Fax:
Practice Address - Street 1:33 ELIZABETH ST
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10310-1933
Practice Address - Country:US
Practice Address - Phone:646-567-8635
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-15
Last Update Date:2020-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY820674251300000X
174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
No174400000XOther Service ProvidersSpecialist