Provider Demographics
NPI:1326375023
Name:RAMIREZ, OCTAVIO (LCSW)
Entity Type:Individual
Prefix:
First Name:OCTAVIO
Middle Name:
Last Name:RAMIREZ
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2220 CANTERBURY DR
Mailing Address - Street 2:
Mailing Address - City:HAYS
Mailing Address - State:KS
Mailing Address - Zip Code:67601-2370
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2214 CANTERBURY DR STE 300
Practice Address - Street 2:
Practice Address - City:HAYS
Practice Address - State:KS
Practice Address - Zip Code:67601-2397
Practice Address - Country:US
Practice Address - Phone:785-623-5160
Practice Address - Fax:785-623-5161
Is Sole Proprietor?:No
Enumeration Date:2009-11-17
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLSCSW056151041C0700X
TN51041041C0700X
AL2245C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL330000014Medicaid
511-01325OtherBCBS OF ALABAMA
511-01325OtherBCBS OF ALABAMA