Provider Demographics
NPI:1972558716
Name:RICHTER, KEITH (LCSW)
Entity type:Individual
Prefix:
First Name:KEITH
Middle Name:
Last Name:RICHTER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 MAIN STREET EXT
Mailing Address - Street 2:PO BOX 1000
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-4406
Mailing Address - Country:US
Mailing Address - Phone:860-343-5300
Mailing Address - Fax:860-343-5307
Practice Address - Street 1:180 WESTBROOK RD
Practice Address - Street 2:
Practice Address - City:ESSEX
Practice Address - State:CT
Practice Address - Zip Code:06426-1517
Practice Address - Country:US
Practice Address - Phone:860-767-2025
Practice Address - Fax:860-767-1053
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-23
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0052871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical