Provider Demographics
NPI:1417637463
Name:RAYMOND, AMY MARY HEATHER (MSW)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:MARY HEATHER
Last Name:RAYMOND
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27069 SW 140TH PATH
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-8844
Mailing Address - Country:US
Mailing Address - Phone:305-215-3750
Mailing Address - Fax:
Practice Address - Street 1:24601 PACKINGHOUSE RD
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33032-3807
Practice Address - Country:US
Practice Address - Phone:305-215-3750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-24
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLISW188581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical