Shetara Richardson, CAADC, LCSW is a medicare enrolled "Social Worker - Clinical" provider in Philadelphia, Pennsylvania. Her current practice location is
2311 Cottman Ave Ste 71, Philadelphia, Pennsylvania. You can reach out to her office (for appointments etc.) via phone at
(215) 444-7505.
Shetara Richardson is licensed to practice in Pennsylvania (license number CW023741) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1285313957.
Healthcare Provider's Profile
| Full Name | Shetara Richardson |
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| Gender | Female |
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| Speciality | Social Worker - Clinical |
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| Location | 2311 Cottman Ave Ste 71, Philadelphia, Pennsylvania |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1285313957
- Provider Enumeration Date: 07/11/2023
- Last Update Date: 08/14/2024
Medicare PECOS Information:
- PECOS PAC ID: 6305209958
- Enrollment ID: I20230829003999
Medical Identifiers
Medical identifiers for Shetara Richardson such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1285313957 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 101YA0400X | Counselor - Addiction (substance Use Disorder) | CW023741 (Pennsylvania) | Secondary |
| 1041C0700X | Social Worker - Clinical | CW023741 (Pennsylvania) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Shetara Richardson allows following entities to bill medicare on her behalf.
| Entity Name | Cleanslate Medical Group Of Pennsylvania Llc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1184177263
PECOS PAC ID: 8426334400
Enrollment ID: O20170405000660 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Shetara Richardson is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
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Shetara Richardson, CAADC, LCSW
Po Box 746722,
Atlanta, GA 30374-6722
Ph: (312) 733-9730 | Shetara Richardson, CAADC, LCSW
2311 Cottman Ave Ste 71,
Philadelphia, PA 19149-1007
Ph: (215) 444-7505 |
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