Individual provider Active NPI

Jennifer Anne Richardson, PSY.D.

  • Clinical Psychologist
  • Land O Lakes, FL
National Provider Identifier
1164638896
Registry record updated Jun 6, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PY10020 Issued in FL
Practice address
20747 Sterlington Dr
Land O Lakes, FL 34638-4317
Phone
(813) 907-9191
Fax
(813) 948-0094
NPI assigned
May 16, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 6, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X
Clinical Psychologist 103TC0700X PY10020 FL Primary

Addresses

Primary practice location

20747 Sterlington Dr
Land O Lakes, FL 34638-4317

Mailing address

20747 Sterlington Dr
Land O Lakes, FL 34638-4317

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200723003429 FL Practitioner - Clinical Psychologist 4688913056 Reassigns benefits to 1 organization
Practice locations: Land O Lakes, FL

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

20747 Sterlington Dr
Land O Lakes, FL 34638-4317
Phone (727) 688-5756

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PY10020FLMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Jennifer Richardson PSYD, PA Clinical CurrentSince Mar 17, 2020 Accepting new patients

Locations

20747 Sterlington Dr
Land O Lakes, FL 34638
Phone (813) 907-9191

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1179273600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1559779200000",
    "number": "1164638896",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20747 STERLINGTON DR",
            "city": "LAND O LAKES",
            "state": "FL",
            "postal_code": "346384317"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20747 STERLINGTON DR",
            "city": "LAND O LAKES",
            "state": "FL",
            "postal_code": "346384317",
            "telephone_number": "813-907-9191",
            "fax_number": "813-948-0094"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RICHARDSON",
        "first_name": "JENNIFER",
        "middle_name": "ANNE",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-05-16",
        "last_updated": "2019-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "FL",
            "license": "PY10020",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Land O Lakes, FL

Sources for this page

Verify at the official NPI Registry.