Provider Demographics
NPI:1396407326
Name:RAYMONDI, KELSEY
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:RAYMONDI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 S MAIN ST STE 100
Mailing Address - Street 2:
Mailing Address - City:NORTH CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44720-4283
Mailing Address - Country:US
Mailing Address - Phone:330-244-8782
Mailing Address - Fax:
Practice Address - Street 1:1201 S MAIN ST STE 100
Practice Address - Street 2:
Practice Address - City:NORTH CANTON
Practice Address - State:OH
Practice Address - Zip Code:44720-4283
Practice Address - Country:US
Practice Address - Phone:330-244-8782
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-07
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.174900101YA0400X
OHC.2103800101YM0800X, 101YP2500X
OHE.2303831101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHCDCA.174900OtherCHEMICAL DEPENDENCY PROFESSIONALS BOARD
OHE.2303831OtherCOUNSELOR, SOCIAL WORKER AND MARRIAGE AND FAMILY THERAPIST BOARD
OHC.2103800OtherCOUNSELOR, SOCIAL WORKER AND MARRIAGE AND FAMILY THERAPIST BOARD