Provider Demographics
NPI:1730429655
Name:RAYMOND, CAROLINE (LCSW,LADC,CCS)
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:
Last Name:RAYMOND
Suffix:
Gender:F
Credentials:LCSW,LADC,CCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-5462
Mailing Address - Country:US
Mailing Address - Phone:207-874-1045
Mailing Address - Fax:207-767-0995
Practice Address - Street 1:525 MAIN ST
Practice Address - Street 2:
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-5462
Practice Address - Country:US
Practice Address - Phone:207-874-1045
Practice Address - Fax:207-767-0995
Is Sole Proprietor?:No
Enumeration Date:2013-03-01
Last Update Date:2013-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1164484093Medicaid