Provider Demographics
NPI:1144382490
Name:SMITH, RAYMOND BERNARD (ASW)
Entity Type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:BERNARD
Last Name:SMITH
Suffix:
Gender:M
Credentials:ASW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:320 SCHOONER RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:DIXON
Mailing Address - State:CA
Mailing Address - Zip Code:95620-4504
Mailing Address - Country:US
Mailing Address - Phone:707-399-4900
Mailing Address - Fax:707-399-4957
Practice Address - Street 1:1745 ENTERPRISE DR
Practice Address - Street 2:SUITE 2M
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-5801
Practice Address - Country:US
Practice Address - Phone:707-399-4900
Practice Address - Fax:707-399-4957
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW113781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical