Provider Demographics
NPI:1669717294
Name:RICHARDS, SALLIE (PSYD)
Entity type:Individual
Prefix:DR
First Name:SALLIE
Middle Name:
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 1:1101 ELK ST
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:PA
Mailing Address - Zip Code:16323-1230
Mailing Address - Country:US
Mailing Address - Phone:304-638-9557
Mailing Address - Fax:
Practice Address - Street 1:19 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:OIL CITY
Practice Address - State:PA
Practice Address - Zip Code:16301-2718
Practice Address - Country:US
Practice Address - Phone:814-678-6900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-08
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1065103TC0700X
PAPS017359103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical