Provider Demographics
NPI:1366924722
Name:BOND, RICHARD J JR (LICSW)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:J
Last Name:BOND
Suffix:JR
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 HATHERLY RISE
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-3598
Mailing Address - Country:US
Mailing Address - Phone:781-551-3471
Mailing Address - Fax:
Practice Address - Street 1:34 HATHERLY RISE
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-3598
Practice Address - Country:US
Practice Address - Phone:781-551-3471
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-02
Last Update Date:2018-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA105283104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA105283OtherLICENCED IND. CLINICAL SOCIAL WORKER