Provider Demographics
NPI:1487125415
Name:RAYGOR, REBECCA J (LCSW-C)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:J
Last Name:RAYGOR
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:WICOMICO HIGH SCHOOL
Mailing Address - Street 2:201 LONG AVE.
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804
Mailing Address - Country:US
Mailing Address - Phone:410-677-5146
Mailing Address - Fax:410-677-5151
Practice Address - Street 1:WICOMICO HIGH SCHOOL
Practice Address - Street 2:201 LONG AVE.
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804
Practice Address - Country:US
Practice Address - Phone:410-677-5146
Practice Address - Fax:410-677-5151
Is Sole Proprietor?:No
Enumeration Date:2018-12-17
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD123711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical