Provider Demographics
NPI:1649338104
Name:RAYMOND, MARLA A (MSW-MHRT/C)
Entity type:Individual
Prefix:MS
First Name:MARLA
Middle Name:A
Last Name:RAYMOND
Suffix:
Gender:F
Credentials:MSW-MHRT/C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 87
Mailing Address - Street 2:
Mailing Address - City:CARIBOU
Mailing Address - State:ME
Mailing Address - Zip Code:04736-0087
Mailing Address - Country:US
Mailing Address - Phone:207-492-1000
Mailing Address - Fax:207-492-1006
Practice Address - Street 1:7 PROSPECT ST
Practice Address - Street 2:
Practice Address - City:CARIBOU
Practice Address - State:ME
Practice Address - Zip Code:04736-2456
Practice Address - Country:US
Practice Address - Phone:207-492-1000
Practice Address - Fax:207-492-1006
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2013-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME432126999Medicaid