Provider Demographics
NPI:1033382643
Name:SPEARS, RAYMOND (MS)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:
Last Name:SPEARS
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:RAYMOND
Other - Middle Name:HUGH
Other - Last Name:SPEARS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS
Mailing Address - Street 1:21 NW 91ST ST
Mailing Address - Street 2:
Mailing Address - City:BRANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32008-7283
Mailing Address - Country:US
Mailing Address - Phone:386-935-9279
Mailing Address - Fax:
Practice Address - Street 1:21 NW 91ST ST
Practice Address - Street 2:
Practice Address - City:BRANFORD
Practice Address - State:FL
Practice Address - Zip Code:32008-7283
Practice Address - Country:US
Practice Address - Phone:386-935-9279
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-04
Last Update Date:2009-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 7585101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health