Provider Demographics
NPI:1639547334
Name:SAWOE-RICHARDSON, ETHEL
Entity type:Individual
Prefix:
First Name:ETHEL
Middle Name:
Last Name:SAWOE-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 1:715 DEVONSHIRE RD
Mailing Address - Street 2:
Mailing Address - City:HAUPPAUGE
Mailing Address - State:NY
Mailing Address - Zip Code:11788-4524
Mailing Address - Country:US
Mailing Address - Phone:631-402-2975
Mailing Address - Fax:
Practice Address - Street 1:13 THOMPSON HAY PATH
Practice Address - Street 2:
Practice Address - City:SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-1317
Practice Address - Country:US
Practice Address - Phone:631-751-0197
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-11
Last Update Date:2015-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health