Provider Demographics
NPI:1407932148
Name:BEDGOOD, RAYMOND ALAN (LMSW)
Entity Type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:ALAN
Last Name:BEDGOOD
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1826 VETERANS BLVD
Mailing Address - Street 2:SATP/MHSL (1165)
Mailing Address - City:DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31021-3620
Mailing Address - Country:US
Mailing Address - Phone:478-272-1210
Mailing Address - Fax:478-277-2857
Practice Address - Street 1:914 N CANAL ST
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:NM
Practice Address - Zip Code:88220-5110
Practice Address - Country:US
Practice Address - Phone:505-885-4836
Practice Address - Fax:505-887-9579
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMM-064191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical