Provider Demographics
NPI:1083102917
Name:RAYMOND, MEGAN LEIGH SMUCKER (LCSW)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:LEIGH SMUCKER
Last Name:RAYMOND
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:LEIGH
Other - Last Name:SMUCKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:161 REMSEN ST APT 2B
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-4324
Mailing Address - Country:US
Mailing Address - Phone:347-504-1272
Mailing Address - Fax:
Practice Address - Street 1:161 REMSEN ST APT 2B
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-4324
Practice Address - Country:US
Practice Address - Phone:347-504-1272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-26
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY101940104100000X
NY0940301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker