Provider Demographics
NPI:1043565625
Name:FERMIN, RAYMUNDO D (LMSW, CASAC)
Entity Type:Individual
Prefix:MR
First Name:RAYMUNDO
Middle Name:D
Last Name:FERMIN
Suffix:
Gender:M
Credentials:LMSW, CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1306 COLLEGE AVE APT 1D
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10456-1541
Mailing Address - Country:US
Mailing Address - Phone:646-457-1468
Mailing Address - Fax:
Practice Address - Street 1:1306 COLLEGE AVE APT 1D
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10456-1541
Practice Address - Country:US
Practice Address - Phone:646-457-1468
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-19
Last Update Date:2015-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY72 0853281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical