Provider Demographics
NPI:1275669624
Name:JONES RAYMOND, SUSAN KIMBERLY (LICSW)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:KIMBERLY
Last Name:JONES RAYMOND
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:KIMBERLY
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:22 CHANNELL DRIVE
Mailing Address - Street 2:
Mailing Address - City:AGAWAM
Mailing Address - State:MA
Mailing Address - Zip Code:01001
Mailing Address - Country:US
Mailing Address - Phone:413-789-0125
Mailing Address - Fax:
Practice Address - Street 1:1221 RIVERDALE STREET
Practice Address - Street 2:BRIGHTSIDE INC
Practice Address - City:WEST SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01089
Practice Address - Country:US
Practice Address - Phone:413-748-9999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10276261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
P21867Medicare ID - Type Unspecified