Provider Demographics
NPI:1437511367
Name:JEANES, RAYMOND EDWIN (LCSW)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:EDWIN
Last Name:JEANES
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:RAYMOND
Other - Middle Name:EDWIN
Other - Last Name:MANGELSDORF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:730 PEACHTREE ST NE STE 570A
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308-1210
Mailing Address - Country:US
Mailing Address - Phone:678-805-7181
Mailing Address - Fax:
Practice Address - Street 1:730 PEACHTREE ST NE STE 570A
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308-1210
Practice Address - Country:US
Practice Address - Phone:678-805-7181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-21
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0110211041C0700X
GACSW0079311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical